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Hong Kong Society for Simulation in Healthcare: Abstracts From the 2017 Annual Conference

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: August 2018 - Volume 13 - Issue 4 - p 295-301
doi: 10.1097/SIH.0000000000000340
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CARDIAC ARREST IN PREGNANCY SIMULATION WORKSHOP (CAPS) FOR O&G NURSES

Hoi-Lam Ho, MN,1 Man-Yin Yip, MSc,1 Lin-Lai Kan, MBA,1 Wai-Ling Leung, MSc,1 Jacky Chan, DN2

1DEPARTMENT OF OBSTETRICS & GYNAECOLOGY, PAMELA YOUDE NETHERSOLE EASTERN HOSPITAL; 2SIMULATION TRAINING CENTRE, HONG KONG CHILDREN’S HOSPITAL, HOSPITAL AUTHORITY

Background: Cardiac arrest is rarely happened in pregnancy but when it occurs, the lives of pregnant woman and her fetus are endangered. Therefore, a 90-minute Cardiac Arrest in Pregnancy Simulation Workshop (CAPS) was first developed by the Department of O&G, PYNEH in 2015 and is conducted annually for updating O&G nurses with the latest AHA guideline.

Methods: It was a cross-sectional study that conducted from October 2016 to February 2017. 96 nurses were recruited in this study. Learners were required to attend a 20-minute lecture with video demonstration on the management of maternal cardiac arrest. Then, 4 learners worked as a team to resuscitate a pregnant woman who had cardiac arrest in 2 different simulation scenarios with debriefing conducted after each scenario. Pre and post-tests which consisted of 10 multiple choice questions on the knowledge of maternal cardiac arrest management were conducted on individual basis before and after the simulation workshop. Practical assessment on their CPR skills was performed on team basis using checklist for CPR drill. Paired t-test and Chi-square test were used for analyzing pre and post-test scores and checklist items achieved in scenarios respectively.

Results: 84.4% of learners were registered midwives, 11.4% were registered nurses and 4.2% were enrolled nurses. For the written assessment with passing score 5 out of 10, 30.2% of learners passed the pre-test with mean score 3.86 (95%CI=3.59-4.14). All of them passed the post-test with mean score 8.20 (95%CI=7.96-8.44). Learners in average showed 4.32 increment in post-test score (p<0.001, 95%CI=3.99-4.64). For the practical assessment, 83.3% of teams performed better in the second scenario with more checklist items being achieved in the second scenario. There were statistically significant differences in 4 checklist items with better performance in the second scenario including “Check laryngoscope for adequate lighting and proper functioning” (p=0.022), “Check for leakage of ETT cuff” (p<0.001), “Prepare a working suction” (p=0.010) and “Prepare vasopressor” (p=0.019).

Conclusion: CAPS can strengthen nurses’ knowledge and skills on managing maternal cardiac arrest within a short period of time.

USING SIMULATION AS A METHODOLOGY FOR TRAINING DOCUMENTATION OF NEW RESUSCITATION RECORD FORM

Hoi-Lam Ho, MN,1 On-Chi Li, MN,1 Yuen-Yi Chan, MPHC,1 Yuk-Tong Poon, MSc,1 Chun-Li Tsui, BSc,1 Yee-Wan Lau, MSc,1 Wai-Ling Leung, MSc,1

1DEPARTMENT OF OBSTETRICS & GYNAECOLOGY, PAMELA YOUDE NETHERSOLE EASTERN HOSPITAL

Background: A new resuscitation record form was developed to supplement narrative nursing documentation on neonatal resuscitation. In order to let frontline midwives to be familiar of the new form, a simulated scenario of an extensive neonatal resuscitation involving positive pressure ventilation, chest compressions, medications and thoracentesis with trainers playing the roles of pediatricians and midwives was recorded in a video. Subjects immersed themselves as part of the resuscitation team and adopted the role of recorder while watching the simulated resuscitation video. They recorded baby’s vital signs and interventions using the new form.

Methods: It was a cross-sectional study that conducted from March to April 2017. 29 midwives working in the labor ward were recruited in this study. Subjects were required to read the written instructions and attend briefing regarding documentation using the new form. Then, they had to fill in the form individually while watching a 10-minute video of a simulated extensive neonatal resuscitation. 34 items were checked from their documentation for their compliance to the instructions of documentation. Descriptive statistics was used for data analysis.

Results: On average, subjects recorded around 24 items correctly in their documentation (95%CI=21.90-25.69). 20 subjects on average could perform correct documentation for each item being assessed (95%CI=18.06-22.53). There were 11 items with the rate of achieving correct documentation below mean, including time of event, color of baby, oxygen concentration, start and termination of using self-inflating bag, use of T-piece resuscitator, failed and successful endotracheal intubation attempts, transillumination test for diagnosing pneumothorax, informing receiving pediatric ward and transferring baby out of the resuscitating area. Reinforcement of proper documentation on these 11 items is required.

Conclusion: Simulation of resuscitation is useful for training midwives to fill in the new resuscitation record form as their understanding and compliance to the instructions of documentation can be assessed by recording the same simulated resuscitation. Areas with incorrect documentation are identified and feedback of proper documentation can be given accordingly for increasing the accuracy of documentation.

USING SIMULATION-BASED TRAINING AS A TOOL FOR GUIDELINE DISSEMINATION

C.K. Lai, Peter, MN,1 T.M. Choo, MN,1 W.K. Kwok, MSc (Cardiology),1 T.B. Chan, MMedSc,1

1DEPARTMENT OF ADULT INTENSIVE CARE, QUEEN MARY HOSPITAL, HONG KONG

Background: Simulation-based training is well recognized as an effective methodology for clinical skill training. We described our experience in conducting simulation classes to disseminate a newly released institution guideline on management of clinical emergencies associated with tracheostomy.

Methods: A 1.5-hour training session with four different clinical scenarios was developed. Participants were required to identify and solve the problems independently. Debriefing with standardized training materials were conducted after each scenario.

Results: 262 nurses participated in thirty four identical sessions between January and May 2017. Mean year of service was 3.03±0.71. 91.0% and 62.2% had former experience in care of patients with temporary and permanent tracheostomies, of which 54.2% and 36.2% had experience in managing emergencies associated with temporary and permanent tracheostomies. 55.4% had attended classroom approach of tracheostomy training within the last six months. 155 participants preferred simulation class to didactic lectures. Overall satisfaction score, program effectiveness in meeting training needs and degree of simulation realism were 5.34±0.00/6, 5.39±0.71/6 and 7.88±0.71/10 respectively. Participants’ self-reported confidence and competence before and after training were 5.16±2.12/10 versus 7.43±0.71/10 (mean difference = 2.27, p<0.001) and 5.51±2.83/10 versus 7.35±0.71/10 (mean difference = 1.84, p<0.001).

Conclusion: Comparing with traditional classroom instruction, simulation-based training is better received and at least equally effective. The activity is participant-centered and more time can be spent in developing higher-order cognitive skills. Thus it is a superior methodology for disseminating guidelines related to management of clinical emergencies.

DESIGN A SIMULATION-BASED LEARNING PROGRAM FOR NURSING STUDENTS TO ENHANCE CLINICAL COMPETENCE: AN INTEGRATIVE REVIEW

Suet-Lai Wong, MN,1 S.T. Wu, Cynthia., PhD,2 Lorna. K.P. Suen, PhD,2

1SCHOOL OF NURSING & HEALTH STUDIES, THE OPEN UNIVERSITY OF HONG KONG; 2SCHOOL OF NURSING, THE HONG KONG POLYTECHNIC UNIVERSITY

Background: The pedagogical value of simulation design should be considered to enhance nursing students’ clinical competence on the areas of health assessment since the simulation-based learning has been adopted in nursing education generally. An integrative literature review was undertaken to examine the development process of simulation based learning to enhance clinical competence on health assessment specifically. Data sources include CINAHL, ERIC, MEDLINE, ProQuest Education Journals and ProQuest Nursing. The search was limited to articles published in English between 2006 and 2016.

Methods: Five broad search categories were used: nursing students, simulation, teaching and learning, clinical education and competence. This search yielded 261 matching publications, which were screened further by examining each of abstracts, following by an in-depth review. Eleven full-text articles were extracted and analyzed using an inductive approach to extract statements for categorization and synthesis for the design of a simulation based learning program.

Results: The design of innovative simulation based learning were undergone four stages including the setting up of pedagogical goals, adopting developmental strategies, delivering key instructions and evaluating key students’ performance. The pedagogical goals should be to ensure deep and integrative learning via a series of sessions throughout the curriculum. Adopted developmental strategies consisted of consulting with specialists, building simulations with controllable complexity, and creating sequential contents in a storyline of scenario. The deliverable instruction approaches should be aligned with the pedagogical goals including advanced organizer, drills & practice, experiential learning and collaborative inquiry. Students’ key performance should be evaluated finally including knowledge, skills of health assessment, clinical judgment, satisfaction, and self-confidence.

Conclusion: A program of Simulation Based Health Assessment can be derived accordingly to enhance clinical competence for undergraduate nursing students.

THE CHALLENGE OF INTEGRATING SIMULATION IN NURSING EDUCATION

Agnes Tiwari, PhD,1 Manbo Man, EMBA,1 Gloria Hung, MSc,1

1HONG KONG SANATORIUM & HOSPITAL, HONG KONG

Background: Although authentic clinical experiences have traditionally prepared nursing students for entry into practice, there are increasing barriers to optimizing students’ clinical learning including the availability of high-quality clinical experiences. While sophisticated patient simulators have the potential to prepare nurses for an increasingly complex health care environment, literature has shown that integrating simulation in nursing education is challenging.

Methods: Using a case-study method, this study aimed to identify the challenges associated with the integration of high-fidelity human simulators in prelicensure and postlicensure nursing programs in a private health care setting in Hong Kong. Data were collected through in-depth examination of the minutes of meetings in which simulation education was discussed, annual reports and curriculum reviews, historical artifacts of simulators in nursing skills laboratories, and education simulation projects in the organization under studied.

Results: The challenges were multi-faceted, at the organizational, developmental, curricular, and technological level. Specifically, the organization’s endorsement of advancing nursing education and promoting safe practice through high-fidelity simulation is vital. This would ensure adequate funding for initiating and sustaining the state-of-the-art simulation technology, physical space, and faculty development. A learning culture at all levels of the organization is essential to ensure commitment and multidisciplinary collaboration across service and education, as well as among nursing and non-nursing personnel. Conceptualization and operationalization of high-fidelity simulation in prelicensure and postlicensure nursing programs require vision, leadership, and trust for all those involved in providing or receiving simulation pedagogy. A systematic evaluation plan is crucial for determining the effects of the new teaching paradigm and generating evidence to inform continuing improvement in adopting simulation pedagogy and technology.

Conclusion: The challenge of integrating simulation in nursing education is best tackled through a supportive organizational environment, commitment and collaboration among the users and facilitators of simulation pedagogy, and continuing evaluation and improvement.

LEARNER CENTERED CURRICULUM DESIGN – LEARNERS’ CONTRIBUTION IN KNOWLEDGE AND SKILL TRANSFER DESIGN IN THE RESPIRATORY FAILURE MANAGEMENT COURSE

E.H.K. So,1 C.K. Ng,2 C.H. Lau,3 A.S.H. Leung,1 W.H. O,2 M.P.K. Lit,2 S.K. Yung,4 J.K.C. Shek,4 I.L.O. Lo,3 R.P.W. Leung,4 G.W.Y. Ng,1 J.W.M. Chan,2 N.H. Chia,1

1MULTI-DISCIPLINARY SIMULATIONS AND SKILLS CENTRE, QUEEN ELIZABETH HOSPITAL, HOSPITAL AUTHORITY, HONG KONG; 2DEPARTMENT OF MEDICINE, QUEEN ELIZABETH HOSPITAL, HOSPITAL AUTHORITY, HONG KONG; 3DEPARTMENT OF SURGERY, QUEEN ELIZABETH HOSPITAL, HOSPITAL AUTHORITY, HONG KONG; 4INTENSIVE CARE UNIT, QUEEN ELIZABETH HOSPITAL, HOSPITAL AUTHORITY, HONG KONG

Background and Purpose: In some HA hospitals, junior doctors and nurses are required to take care of mechanical ventilation for critical patients in medical and surgical high dependency units. Respiratory physicians (course director), intensivists, anaesthesiologists, nurse specialists and Multidisciplinary Simulation and Skills Centre formed the Steering Committee to develop a corporate training course for these staff.

Methods: The Steering Committee invited surgeon, physician and nurse specialist into the Curriculum Committee for curriculum development. They participated actively in the design of educational content and training modality which included 3 components in this generic cross-disciplinary training curriculum framework. They are: (A) the pre-course e-learning, pre- and post-course tests, (B) Skills stations, (C) Simulation-based scenarios. Training details for the medical team and surgical team were different with respect to e-learning and test materials, skills training and scenarios design. Non-invasive ventilation (NIV) training was only present for medical team. A learners’ evaluation was conducted at the end.

Results: From Aug 2016 to March 2017, 115 doctors and nurses joined 7 classes including 5 medical and 2 surgical ones. 115 completed pre- and post-course tests, and course evaluation. There were statistically significant positive shifts in knowledge for both doctors and nurses in medical classes (16.26%) and surgical classes (31.4%) after training (p<0.05). In course evaluation, both surgical and medical classes reported highly positive responses. They were particularly satisfied with immediate instructor feedback in skills stations and reflective learning during debriefing session. The improvement in post-course test results and learners’ evaluation demonstrated both a significant improvement in knowledge and the learners were highly satisfied with the training (overall satisfaction >99%).

Conclusions: This study demonstrated that early involvement of learner representatives in a generic course design with specific elements added in each specialty contributed to a high learner satisfaction. It also met individual specialty training need with a definite positive shift in relevant knowledge gap.

Acknowledgement: Ms. Wendy Chiu for data process

CUSTOMIZED SILICONE MODEL FOR CANNULATION TRAINING

Wing-Kui Kwok, MSc,1 Wai-Kit Chan, BSc,1 Yuen-Tin Mok, MSc,1 Chi-Keung Lai, MN,1 Chun-Wai Ngai, MD,1

1ADULT INTENSIVE CARE UNIT, QUEEN MARY HOSPITAL, HONG KONG

Background: Vascular cannulation is a common procedure in critical care setting including Extracorporeal Membrane Oxygenation (ECMO) and central venous catheter insertion. Training of cannulation on operators’ skills is crucial to minimize procedure related complications and improve patient safety. To use high fidelity model in cannulation training by applying a customized simulator made of commercial silicone product can improve learners’ experience, knowledge and skills in cannulation.

Methods: The silicone model is designed by Queen Mary Hospital ECMO training team for high fidelity cannulation training. It consists of commercial silicone rubber and silicone tubings to simulate human tissue and blood vessel. The model size and shape can be tailored to mimic different parts of vascular system for cannulation with different approaches such as femoral or jugular insertion, even various tubings configuration for troubleshooting. The model is easy to produce and takes only few hours to cure. The production cost is much cheaper comparing with commercial cannulation model.

Results: Silicone model was adopted in ECMO cannulation training sessions of APELSO ECMO course in 2015-2017 with satisfactory experience (unpublished data). The model is able to provide similar tactile sensation and resistance on human tissue and realistic ultrasound imaging for cannulation including needle penetration to simulated vessel wall. Flash of artificial blood and/ or arterial splashing is also simulated while the puncture needle is in place. The model allows multiple punctures and serial dilatations in a session.

Conclusion: High fidelity silicone model is an ideal choice for standard and safe training modality of vascular cannulation. The model is reproducible and easy to reassemble with low cost according to different training needs for various cannulation procedures. Future application of the model focuses on skill based cannulation (e.g. Intra-aortic balloon pump catheter, percutaneous tracheostomy, etc.) and integration with advanced training scenarios for managing emergency situations involving cannulation.

AN ANIMAL MODEL OF SIMULATED PREDATOR ODOR EXPOSURE: EXPLORING THE POTENTIAL ROLE OF NEUROGENESIS IN SPECIFIC PHOBIA EXTINCTION

Joseph, W.H. Leung, PhD,1 Jada, C.D. Lee, PhD,2 Jackie, N.M. Chan, BSc,1 Timothy, K.H. Fung, BSc,1 Dalinda Sanchez-Vidana, MSc,1 Kwok-Fai So, PhD,3 Benson W.M. Lau, PhD,1

1DEPARTMENT OF REHABILITATION SCIENCES, THE HONG KONG POLYTECHNIC UNIVERSITY; 2DEPARTMENT OF OPHTHALMOLOGY, THE UNIVERSITY OF HONG KONG; 3GHM INSTITUTE OF CNS REGENERATION, JINAN UNIVERSITY, GUANGZHOU, CHINA; CO-INNOVATION CENTER OF NEUROREGENERATION, NANTONG UNIVERSITY, JIANGSU, PR CHINA; MINISTRY OF EDUCATION CNS REGENERATION INTERNATIONAL COLLABORATIVE JOINT LABORATORY, JINAN UNIVERSITY, GUANGZHOU, CHINA

Background: Specific phobia, or phobic disorder, is a subtype of anxiety disorder in which a persistent fear of a specific object can be found in the individual even the object is recognized as unreasonable. Exposure therapy, which is a treatment methods for specific phobia, adopts the concept of contextual extinction process: gradual and repeated presentation of the feared simulus is involved in the treatment to reduce the fear towards the object. Owing to the advance of information technology, virtual reality (VR) and augmented reality (AR) are increasing incorporated into exposure therapy as an advanced simulation method.

Methods: In the present study, an animal model of exposure therapy is simulated by repeated exposure of trimethylthiazoline (TMT), which is a synthetic fox feces odor, to laboratory rats. TMT induces innate fearful response in the rats. The objectives of the present study includes: 1. To test if a simulated stimulation would effectively reduce phobia in an animal model and 2. To explore the underlying mechanisms of the phobia reduction or extinction.

Results: The present result shows that reduction in phobic response can be observed in the animal model, and hippocampal neurogenesis, which is the production of new neurons, is involved in the process.

Conclusion: The present study showed that simulated stimuli may reduce innate fear to specific objects. This suggests that simulation by VR and AR may be useful for exposure therapy. Furthermore, the necessity of neurogenesis for exposure therapy was determined by in the animal model, which suggests this may be a mechanism underlying exposure therapy.

FACILITATED REFLECTION OPTIMIZES STUDENTS’ LEARNING EXPERIENCE IN SIMULATION-BASED PRACTICE IN PHYSIOTHERAPY EDUCATION

Shirley P.C. Ngai, PhD,1 Veronika Schoeb, PhD,1 Raymond W.M. Lo, MSc,1 Margaret, K.Y. Mak, PhD,1

1DEPARTMENT OF REHABILITATION SCIENCES, THE HONG KONG POLYTECHNIC UNIVERSITY

Background: Medical simulation provides an excellent platform for students to keep practicing until reaching satisfactory performance without doing harm to patients. Clinical reasoning, however, is as important as skills practice for healthcare professional to make the most appropriate on-the-spot medical judgment to provide the best management to the patients. This project aims to evaluate students’ perception about their learning experience with the facilitated reflection after simulation-based practice.

Methods: Students volunteered to join the project were divided into small groups of 4-6 to participate simulation-based practice followed by facilitated reflection and debriefing led by academician and clinician specialized in cardiopulmonary physiotherapy. Students were invited for the focused group interview. In total, three focused group interviews (n=6 in each focused group) were conducted. Each interview lasted for 60 minutes with audial recorded. The audio clips were then transcribed into text. Common themes were identified using content analysis.

Results: Three main themes were identified including learning, skills acquisition and motivation. In specific, students expressed that simulated-based practice provided them with good learning experience to have skill practice and hands-on experience on “real” cases, psychologically prepared them for treating cases and understood the importance of collaborative learning e.g. getting advice with the peers during learning. However, they also expressed differences in learning in classroom and clinical settings. The facilitated reflection and discussion during the debriefing session gave them direction to think. By discussing with academician and clinician on specific performance during simulated practice, students expressed that they came to understand what was going wrong in the “reasoning” process and how to fill in the gap between university and clinical teaching.

Conclusion: The study revealed that facilitated reflection followed by the simulation-based practice optimizes students’ learning experience and bridge the learning gap between classroom learning and clinical practice. [supported by The Hong Kong Polytechnic University#LTG15/16-498F]

CAN PERFORMANCE INDICATOR IN VIRTUAL REALITY BE USED FOR EDUCATION PURPOSES IN COMMAND AND COORDINATION TRAINING?

Jacky C.K. Chan, DN,1

1SIMULATION TRAINING CENTRE, HONG KONG CHILDREN’S HOSPITAL, HONG KONG

Background: Although command and coordinator simulation training are very common, it is not easy to measure the performance of participants. This study aims to determine whether the performance indicator in virtual reality could be used to measure performance and identify the gaps in protocols and communication.

Methods: Seventy-Nine healthcare professionals including doctors, nurses and paramedics participated in this study. They were divided into eight groups in a motorsport command and coordination training. During the training, they were assigned into ten different roles in different separated location in the floor, namely: Hospital In charge, control centre operator, track-side paramedic, few ambulance in-charge…etc. All groups did the same scenario using the virtual reality software. All events were input in the time log and those computer console screens were video recorded for further analysis. The performance indicators were compared among 8 scenarios in Figure 1 and Table 1.

Result: Participants agreed that the course could help them identify the gap and understand more about medical command and coordination during motorsport mass gathering events (Mean =4.44, S.D. = .56). (n=72) (Likert scale: Very Disagree = 1, Strongly agree= 5) (Figure 1).

F1

Conclusion: The performance indicator in the virtual reality simulation proved to be an effective tool to measure performance of healthcare professionals, and let them understand how to handle the multiple causalities situation in motorsport mass gathering event. Service and protocol gap can be tested and identified during the virtual reality simulation with the different in the performance indicator between teams. Few feedback and suggestion to the race director and those healthcare professionals are made based on the video finding.

AN EVENT-BASED APPROACH TO TEACH SIMULATION SCENARIO DESIGN

George K.C. Wong, MD,1

1DEPARTMENT OF SURGERY, PRINCE OF WALES HOSPITAL, THE CHINESE UNIVERSITY OF HONG KONG, HONG KONG

Background: Stimulation is named as a useful and effective tool for teamwork training and assessment, especially in interprofessional training. Simulation scenario design is one of the key component. We explore a general methodology to teach scenario design.

Methods: We searched PubMed between 1 Jan 2004 and 31 Aug 2016 using the keywords on “teamwork” AND “assessment” AND “medical simulation”. We retrieved and reviewed the articles relevant to scenario design and reflect on methodology to teach scenario design.

Results: A total of 101 articles were retrieved and reviewed. We identified and explored an event-based approach. We examined the processes against a list of key elements that would facilitate learning and running of scenario. Simulation scenarios are constructed to identify any potential obstacle in applying the event-based approach.

Conclusion: The event-based approach fulfills the four essential features for effective simulation and includes key elements that would facilitates learning and running of scenario. An event-based approach is a recommended framework to teach scenario design.

USING HIGH-FIDELITY SIMULATION FOR NURSE POST GRADUATE YEAR (NPGY) IN EMERGENCY MEDICINE DEPARTMENT

Pei-Yin Liu, BN,1 Li-Ping Ke, BN,1 Chih-Wei Hung, MD,2 Chu-Feng Liu, MD,2 Chien-Hung Wu, MD,2

1DEPARTMENT OF NURSING IN EMERGENCY MEDICINE, KAOHSIUNG CHANG GUNG MEMORIAL HOSPITAL, CHANG GUNG UNIVERSITY COLLEGE OF MEDICINE, NO. 123, DAPI RD, NIAOSONG TOWNSHIP, KAOHSIUNG COUNTY 833, TAIWAN; 2DEPARTMENT OF EMERGENCY MEDICINE, KAOHSIUNG CHANG GUNG MEMORIAL HOSPITAL, CHANG GUNG UNIVERSITY COLLEGE OF MEDICINE, NO. 123, DAPI RD, NIAOSONG TOWNSHIP, KAOHSIUNG COUNTY 833, TAIWAN

Background: Nurse Post Graduate Year (NPGY) program is important for developing nursing medical education in Taiwan since 2007. Since the characteristics of emergency patients are emergency, severe, difficult and troublesome, it is an extremely challenging for NPGY members to accommodate and manage these patients in first few months. The appropriate uses of simulation based training can enhance the teaching and learning for NPGY in emergency medicine department.

Methods: In 2016, we designed a monthly training course using high-fidelity simulation for NPGY members of emergency medicine training. Trainees were divided into pairs and each pair participate one scenario. They assessed by standardized written tests before (Pre-test) and after the course (Post-test) after each simulation session. 42 NPGY members of the emergency medicine department participated this training course between May 2016 and November 2016.

Results: During May to November 2016, 42 NPGY members attended this training course and 42 questionnaires were collected and analyzed using paired t-test (100%). The mean score of Self-Confidence in the pre-test is 2.4 and that in the post-test is 4.1 (p < 0.001). The mean score of Communication Skills in the pre-test is 2.4 and that in the post-test is 3.9 (p < 0.001). The mean score of Leadership in the pre-test is 2.1 and that in the post-test is 3.5 (p < 0.001). The mean score of Situation Monitor in the pre-test is 3.2 and that in the post-test is 4.2 (p < 0.001). The mean score of Mutual Support in the pre-test is 3.2 and that in the post-test is 4.3 (p < 0.001). The average of training course satisfaction is 4.9.

Conclusion: High-fidelity simulation provides a harmless, repetitive and effective environment. It can improve quality and ability of NPGY members in critical care training education and will increase patient safety in health care. For further educational programs, we suggest high-fidelity simulation combined with clinical patient safety policies for all health-care providers to reduce the incidence of medical errors.

VALIDATION PROCESS FOR NUMBER OF SCENARIO IN A SIMULATION COURSE

H.B. Chan, MBBS, FRCPCH,1 Jacky. C.K. Chan, DN,1

1SIMULATION TRAINING CENTRE, HONG KONG CHILDREN’S HOSPITAL, HONG KONG

Introduction: The method of validating the length of the simulation based education course or the number of scenario remaining as a question. Using performance checklist with statistic method is a hypothesized method for validating the number of scenario in the course.

Methodology: It was a prospective cross-sectional study. We developed a 22-item scenario performance checklist to measure students’ learning progresses, as a group, during the course. Each group consisted of 5 students and was assessed as a group. The checklist was implemented in the format of 4 STABLE (Sugar, Temperature, Airway, Breathing, Lab work and emotional support). Provider course in the Hong Kong Hospital Authority through the Accident & Emergency Training (A&E) Centre on 21 Jun 2015 to 31 Jan 2016. In total, 80 nurses from 17 A&E and 8 Neonatal intensive care unit (NICU) in Hong Kong took the course. Descriptive statistic with plot diagram and ANOVA were used for data analysis.

Result: Eighty participants completed 64 scenarios. The Scenario 1 performance was 76.1% (95% CI=71.03 – 81.16, S.D. 9.5); Scenario 2 performance was 80.45% (95% CI = 76.48 – 84.42, S.D. 7.45); Scenario 3 performance was 83.89% (95% CI=80.78 – 87.0, S.D. 5.83); Scenario 4 Performance was 88.08% (95% CI=83.46 – 92.69, S.D. 8.96). Those scenario results were shown as box plot diagram demonstrating a learning curve in Figure 1. These data suggested that student learning was saturated by 4 scenarios. Overall improvement was tested by one-way ANOVA test, =11.98%, F = 6.5, p=0.001.

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Conclusion: Using performance checklist with descriptive statistic and test are useful for validating the length or the number of scenario in a simulation course.

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