PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 15910434

Blurring the boundaries: scenario-based simulation in a clinical setting.

R L Kneebone·J Kidd·D Nestel·A Barnet·B Lo·R King·G Z Yang·R Brown
View original source ↗Export metadata ↓

Abstract

CONTEXT: The ability to perform clinical procedures safely is a key skill for health care professionals. Performing such procedures on conscious patients is challenging and requires a combination of technical and communication skills. We have developed quasi-clinical scenarios, where inanimate models attached to simulated patients provide a convincing learning environment. Procedures are rated by expert observers and by the 'patient' and recorded for subsequent review. This study explores the potential of locating such scenarios within a real clinical setting, allowing participants to experience the challenges of the workplace while ensuring patient safety. An innovative portable digital recording device (the 'Virtual Chaperone') is evaluated for use in clinical settings. METHODS: A qualitative design (observation and interview studies) investigated volunteer medical students undertaking 2 procedure scenarios (insertion of urinary catheter and wound closure with sutures) within the accident unit of a large London hospital. All procedures were observed in real time and recorded digitally (using the Virtual Chaperone). A protocol was used for structured feedback. Observational and interview data was analysed using standard qualitative techniques. RESULTS: Seven sessions with 22 undergraduate medical students took place over 9 months within 1 centre. Data confirmed the feasibility of using a moveable, self-contained training scenario within an authentic clinical setting. Overall, the response from participants was positive. CONCLUSION: Scenario-based teaching within an authentic clinical environment is feasible and perceived by participants to be educationally useful. This approach blurs traditional boundaries between skills laboratory teaching and clinical practice and may offer considerable advantages in training for clinical procedures.

Explore related subjects

Clinical CompetenceCommunicationEducation, Medical, UndergraduateEnglandManikinsRole PlayingTeachingTeaching MaterialsJournal ArticleResearch Support, Non-U.S. Gov't

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

R L Kneebone, J Kidd, D Nestel, A Barnet, B Lo, R King, G Z Yang, R Brown. 2005. Blurring the boundaries: scenario-based simulation in a clinical setting.. https://doi.org/10.1111/j.1365-2929.2005.02110.x

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

The feasibility of three-dimensional displays of the thorax for preoperative planning in the surgical treatment of lung cancer.

OBJECTIVE: Three-dimensional (3D) displays of anatomic structures have become feasible for preoperative planning in some surgical procedures. There have been no reports, however, on the use of 3D displays for surgical treatment of lung cancer. We hypothesized that 3D displays of the thorax are useful for preoperative planning for lung cancer. METHODS: Based on virtual reality technologies, we rendered 3D displays of the thorax from two-dimensional (2D) computed tomographic (CT) images of six anonymous patients, some of whom underwent surgical removal of lung cancer. For determining the resectability of lung cancer, we tested 17 participants with varying degrees of surgical skills to view 3D displays and read 2D CT images of these thoracic cavities in a randomized order. We measured their performance in terms of the accuracy of predicted resectability, the confidence of their prediction, planning time used, and workload experienced. RESULTS: The results demonstrated that viewing 3D displays of thoracic cavities has significant advantages over reading 2D CT images in determining the resectability of lung cancer: increasing the accuracy of predicted resectability by about 20%, enhancing the confidence of the prediction by about 20%, decreasing planning time by about 30%, and reducing workload by about 50%. All participants preferred viewing 3D displays to reading 2D CT images for preoperative planning. Junior residents found 3D displays of thoraces more useful than senior residents. CONCLUSIONS: It is feasible to use 3D displays of the thorax for preoperative planning in treating lung cancer. Using 3D displays in surgical treatment of lung cancer has potential benefits, once the technique is perfected.

Clinical Competence↗
PubMed2007

The learning curve in the training of percutaneous nephrolithotomy.

OBJECTIVES: To investigate the learning curve in the training of percutaneous nephrolithotomy (PCNL). METHODS: A total of 104 PCNL cases were included in this evaluation to define the learning curve of a surgeon with no previous experience at performing solo PCNL. Two parameters of expertise were reviewed, namely the operation and fluoroscopic screening times. The operation time was calculated as the beginning of access with the needle until the nephrostomy tube was placed and secured. PCNL procedures were analyzed in seven sets of 15 cases regarding the operation and fluoroscopy times, stone size, stone clearance rate, blood transfusion rate, and estimated blood loss. RESULTS: The mean operation time was 2.4 h for the first 15 patients. It decreased to a mean of 1.5 h for cases 46 through 60. No further decrease in the operation time was observed after case 60. The fluoroscopic screening time was a peak of 17.5 min in the first 15 cases, whereas it dropped to a mean of 8.9 min for cases 46 through 60. The decline in the mean fluoroscopy screening time continued in cases 61 to 104, but the decline was not significant. There was no significant difference in stone size, stone clearance rate, blood transfusion rate, and estimated blood loss among each set of cases. CONCLUSIONS: This study suggests that the surgical competence in PCNL can be reached after 60 cases. PCNL and fluoroscopy times drop to a steady-state level after performing 60 procedures.

Clinical Competence↗
PubMed2007

Critical overview of the management of neonatal jaundice in the UK.

AIM: To determine the current management of early neonatal jaundice in the UK and to evaluate whether the current practices are evidence based. METHODS: A questionnaire survey was carried out among identified lead paediatricians of neonatal intensive care units. RESULTS: The survey found markedly differing practices for the recognition, investigation and treatment of neonatal jaundice. This applies particularly to confirmation of the clinical suspicion of jaundice; use of invasive and non-invasive technologies for diagnosis; preferred wavelength and intensity of light used for treatment; and whether birth weight, gestational age and postnatal age should influence treatment. CONCLUSION: The study found a lack of consistency in the management of jaundiced infants in the UK. The evidence-based practice currently available does not appear to have been incorporated into treatment protocols.

Clinical Competence↗