The effect of high-fidelity simulation in medical nursing based on the healthcare simulation standards of best practice

Background:High-fidelity simulation has been demonstrated to make great progress in learning.However,there is still ongoing exploration on how to fully harness the advantages of this teaching method and enhance its effectiveness.This study conducted high-fidelity simulation in medical nursing based on the Healthcare Simulation Standards of Best Practice and evaluated its effect.Methods:The study was conducted from September 2019 to June 2020.A total of 82 undergraduate nursing students from a university in Shanghai participated in the high-fidelity simulation in medical nursing.The simulation design scale,educational practices in simulation scale,and students’satisfaction and self-confidence were used to evaluate the effect.Results:The mean score of simulation design scale was 4.06±0.63 with the mean scores of all dimensions being over 3.0.The mean score of educational practices in simulation scale was 4.14±0.56 with the mean scores of all dimensions being over 4.0.The mean scores of students’satisfaction and self-confidence were 4.07±0.72 and 3.89±0.58,respectively.Conclusion:Students reported high levels of simulation design and educational practices in simulation.They were also satisfied with learning and reported high levels of self-confidence.Some key points need to be considered so that the learning effects might be optimized.

A review of clinical reasoning in nursing education:based on high-fidelity simulation teaching method

Objective： Clinical reasoning is an essential feature of health care practice; it is also a crucial ability for providing patient care of high quality. It has been identified that graduate nurses may lack the clinical reasoning skills to deliver safe and effective patient cam. It is therefore of paramount importance to enhance nursing students＇ clinical reasoning ability. High-fidelity simulation （HFS） is proved to be an effective teaching and learning method, which may also have some advantages over other teaching methods. Methods： The authors retrospectively reviewed the related literature, illustrated the application of high-fidelity simulation teaching method in nursing education, putting the focus on the use of it in teaching with clinical reasoning. Results： The application of high-fidelity simulation to nursing education can simulate the clinical situation, thus to create a safe, continuous and efficient learning environment for students, and it can effectively improve students＇ clinical reasoning ability. Conclusions： high-fidelity simulation is effective for clinical reasoning teaching in nursing education. The extension of its application in China should be of great value. The relevant further study is suggested focusing on how to overcome its own limitations and have it better applied in nursing education in China.

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation:a Delphi consensus study

Objective:This study is aimed to develop student simulated patient(SSP)training content and evaluation indicators,and further explores their validity and reliabilities.Methods:Delphi consultations with 20 nursing exper ts were conducted.The weights of indicators were calculated through the analytic hierarchy process.SSP training was conducted with a high-fidelity nursing simulation.Results:The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation.The expert authority coefficient was reported as 0.87.The training included role and responsibility of simulated patient(SP),script interpretation,plot performance,and training for a rater,with a total of 17 indicators.SSP evaluation consisted of disease knowledge,role portrayal,and performance fidelity and since being a rater,it consists of 20 indicators in total.The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918.The content validity of SSP evaluation indicators was 0.95.The inter-rater reliability was repor ted as 0.866,and the internal consistency established using Cronbach’sαwas 0.727.Conclusions:Students as SPs should have first-hand knowledge and experience within the simulated scenarios.SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process.The evaluation indicators were valid and reliable,and provided the objective and quantifiable measurements for SSP training in nursing。

Development of an intensive simulating training program in emergency medicine for medical students in China

BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.

Optimized Reimbursement Scheme of China's New Cooperative Medical System Using Monte Carlo Simulation

China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health insurance of any kind, illness has emerged as a leading cause of poverty[24]. To address the poor state of health care among the rural population, in 2003 the Chinese government launched the New Rural Cooperative Medical System （NCMS）,

Medical simulation-based education improves medicos' clinical skills

Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. There are few opportunities for students to practice their clinical skills and their dexterities are generally at a low level. Medical simulation-based education is a new teaching modality and helps to improve medicos＇ clinical skills to a large degree. Medical simulation-based education has many significant advantages and will be further developed and applied.

A data-based photonuclear simulation algorithm for determining specific activity of medical radioisotopes

For simulating more accurately neutron or proton production from photonuclear reactions,a data-based photonuclear reaction simulation algorithm has been developed.Reliable photonuclear cross sections from evaluated or experimental database are chosen as input data.For checking the validity of the use of the data-based photonuclear algorithm,benchmarking simulations are presented in detail.We calculate photonuclear cross sections or reaction yield for ~9Be,^(48)Ti,^(133)Cs,and ^(197)Au and compare them with experimental data in the region of incident photon energy below ~30 MeV.While Geant4 can hardly reproduce photonuclear experimental data,results obtained from the data-based photonuclear algorithm are found in good agreement with experimental measurements.Potential application in estimation of specific activity of radioisotopes is further discussed.We conclude that the developed data-based photonuclear algorithm is suitable for an accurate prediction of photoninduced neutron or proton productions.

Merging Drama with Medical Education: Simulation in Learning Breaking Bad News Pre- and Post-Study

Objective: Using simulation in medical education was introduced in the 17th century, applying different techniques. The introduction of using simulated patients (SP) was also of great importance in both learning and evaluation processes. Aims: This current study aims at assessing medical students’ perception about the use of well-trained drama students from the school of Arts in simulated session of breaking bad news encounter. Study Design: This is a per- and post-test study. Methods: 112 students were asked to fill a pre-validated questionnaire, who trained from January 2017 till the end of July 2017 pre- and post-exposure to simulated clinical encounter, where one well trained senior drama student played the role of patient, one student played the doctor who would break the bad news (BBN), debriefing before the encounter, and discussion after took place. Another validated questionnaire was distributed after the encounter, to assess the students’ experience. Statistical analysis was done using SPSS version 20. Results: Scores of all questions showed statistically significant improvement after the simulation session (p-value Conclusion: Simulation encounter, using drama students who are well-trained in human grief reaction, making BBN learning more positive and effective, merging two faculties improved the learning experience of both medical and Drama students.

Evaluation of undergraduate students’nursing assessment and communication skills through an objective structured clinical examination within a high-fidelity simulation using a student-simulated patient

Objective:To evaluate nursing students’assessment and communication skills through an objective structured clinical examination(OSCE)within a high-fidelity simulation using a student-simulated patient(SSP)and analyze the validity,reliability,degree of difficulty,and discriminability of the OSCE.Methods:A descriptive study was conducted at one nursing school in Macao.All scenarios were designed using a high-fidelity simulator combined with SSPs.A convenience sample of 54 baccalaureate nursing students completed the OSCE.The nursing assessment OSCE checklist(NAOC)and the communication evaluation rubric(CER)were used as observational measurements with three-point Likert scales(2=Achieved,1=Partly achieved,0=Not completed/Incorrect).Results:Difficulty coefficients of the exam were 0.63 for nursing assessment skills and 0.56 for communication skills.The discrimination index of the majority items of the NAOC(86.4%)was>0.20,showing a better to good discriminability.The items of the CER had satisfactory indexes of item discrimination(from 0.38 to 0.84).Students received high scores in conducting blood oxygen saturation and cardiac and lung auscultation but low scores in vomiting and diarrhea assessment.Students presented good communication skills in eye contacting and listening,but culture assessment needs to be improved.The students with experiences in simulation or simulated patient(SP)interactions had better assessment and communication skills than students without those experiences.There was a positive relationship between nursing assessment and communication skills(r=0.67,P=0.000).Conclusions:SSPs were involved in enhancing the realism of interactions in simulated scenarios.Nursing students can conduct nursing assessments specific to patient conditions,explain the conditions to the patient,and ensure that the patient remains informed at all times of the precautions to be taken.However,students’cultural awareness and some communication skills need further training.With moderate difficulty and high discrimination index,OSCE showed satisfactory reliability and validity.

The future of simulation in medical education

Simulation has made significant in-roads into the provision of medical education over the past twenty years. Simulation made its first impact in specialities such as emergency medicine and anaesthetics; however, it is now being used as an educational modality in a diverse range of specialities - from general practice to psychiatry. Perhaps the greatest pointer of the success of simulation is that it is now increasingly being seen as embedded in medical education and no longer something new and different. So now is probably an appropri- ate time to consider the future of simulation. Where will simulation go next？ It is likely that a number of different themes will emerge.

Application Research of Medical Imaging Practical Teaching Based on Virtual Simulation Teaching Platform

Objective:To explore the application effect of virtual simulation teaching platform in the practical teaching of medical imaging.Methods:A total of 97 students majoring in medical imaging technology of class 2022 were selected and divided into two groups according to the random number method:control group(n=48)and observation group(n=49).The observation group was under the practical teaching mode based on the virtual simulation teaching platform,while the control group was under the traditional multimedia teaching mode.Questionnaire survey and teaching assessment were carried out after the teaching period,and the application effects of the two teaching modes were compared.Results:The reading and theoretical scores of the students in the observation group were significantly higher than those of the students in the control group(P<0.01);there were statistically significant differences in the results of the questionnaire survey(improved learning interest,improved language expression,improved ability to comprehensively analyze problems,and improved teamwork awareness)between the two groups of students(P<0.05);the students in the observation group were markedly more satisfied with the teaching content,teaching methods,and teaching quality than the students in the control group(P<0.05).Conclusion:The medical imaging practical teaching mode based on virtual simulation platform not only helps improve students’theoretical understanding and practical ability in medical imaging technology,but also improves students’learning interest,language expression ability,ability to comprehensively analyze problems,communication skills,teamwork awareness,and satisfaction with the teaching content,teaching methods,and teaching quality.Therefore,it has wide application value in medical specialty education.

Study on the Integration of Professional Ethics in Medical Interpretation Course Based on Situational Simulation Teaching Method and Virtual Reality Technology

Based on the theory of situational simulation,the article explores the approach to building the medical interpretation course from three aspects,which are the objective,design,and teaching model.The course aims to cultivate high-quality medical interpreting talents and enhance students’practical interpretation skills,as well as to integrate professional ethics into teaching.Thus,it is necessary for lecturers to change their teaching philosophy,apply information technology,and improve teaching design.Through rich medical interpretation course,lecturers can promote the integration of professional ethics in medical interpretation.

Application of Mixed Reality Technology in Visualization of Medical Operations

With the continuous progress of virtual simulation technology,medical surgery visualization system has been developed from two-dimensional to three-dimensional,from digital to network and intelligentization.The visualization system with mixed reality technology will also be used in all stage of medical surgery,such as case discussion,surgical planning,intraoperative guidance,post-operative evaluation,rehabilitation,so as to further promote high intelligence,high precision of medical surgery,and consequently improve effectiveness of treatment and quality of medical service.This paper discusses the composition and technical characteristics of medical operation visualization system based on mixed reality technology,and introduces some typical applications of mixed reality technology in medical operation visualization,which provides a new perspective for the application of mixed technology in medical surgery.

Implementation of high-fidelity neutronics and thermal–hydraulic coupling calculations in HNET

To perform nuclear reactor simulations in a more realistic manner,the coupling scheme between neutronics and thermal-hydraulics was implemented in the HNET program for both steady-state and transient conditions.For simplicity,efficiency,and robustness,the matrixfree Newton/Krylov(MFNK)method was applied to the steady-state coupling calculation.In addition,the optimal perturbation size was adopted to further improve the convergence behavior of the MFNK.For the transient coupling simulation,the operator splitting method with a staggered time mesh was utilized to balance the computational cost and accuracy.Finally,VERA Problem 6 with power and boron perturbation and the NEACRP transient benchmark were simulated for analysis.The numerical results show that the MFNK method can outperform Picard iteration in terms of both efficiency and robustness for a wide range of problems.Furthermore,the reasonable agreement between the simulation results and the reference results for the NEACRP transient benchmark verifies the capability of predicting the behavior of the nuclear reactor.

Exhaustive review of acceleration strategies for Monte Carlo simulations in photon transit

Monte Carlo simulation techniques have become the quintessence and a pivotal nexus of inquiry in the realm of simulating photon movement within biological fabrics.Through the stochastic sampling of tissue archetypes delineated by explicit optical characteristics,Monte Carlo simulations possess the theoretical capacity to render unparalleled accuracy in the depiction of exceedingly intricate phenomena.Nonetheless,the quintessential challenge associated with Monte Carlo simulation methodologies resides in their extended computational duration,which significantly impedes the refinement of their precision.Consequently,this discourse is specifically dedicated to exploring innovations in strategies and technologies aimed at expediting Monte Carlo simulations.It delves into the foundational concepts of various acceleration tactics,evaluates these strategies concerning their speed,accuracy,and practicality,and amalgamates a comprehensive overview and critique of acceleration methodologies for Monte Carlo simulations.Ultimately,the discourse envisages prospective trajectories for the employment of Monte Carlo techniques within the domain of tissue optics.

The Effect of Direct Gas Fluorination on Medical Grade Poly(methyl methacrylate)

Medical-grade poly(methyl methacrylate) (PMMA) is extensively employed in the fabrication of a variety of medical implants, including intraocular lenses (IOLs). However, a postoperative complication that leads to the failure of the implanted intraocular lenses has been recently identified. This process, termed calcification, occurs when calcium-containing deposits accumulate on the surface of the IOL. In this study direct gas fluorination was used to modify the surface of PMMA in an attempt to increase the service lifetime of the material in optical applications. PMMA discs exposed to a 20% fluorine/nitrogen gas mixture for 24 h were compared with untreated PMMA discs serving as control samples. Over time, both surface-fluorinated and untreated PMMA samples immersed in a simulated aqueous humour solution (SAHS) (pH 7.4, 35°C) were used to carry out in vitro studies. Attenuated total refractive Infrared spectroscopy (ATR-IR) Scanning electron microscopy (SEM), coupled with Energy dispersive X-ray analysis (EDX), showed that calcium-containing surface deposits were less abundant on surface-fluorinated PMMA compared with the control samples, indicating that the fluorinated surface was acting as a barrier to the deposits. Gravimetric analysis data showed that the decreased rate of diffusion compared with that of a control sample was due to the fluorinated surface.

Mechanical Design of Long-Term Body-Adhered Medical Devices to Maximize On-Body Survival

Long-term, body-adhered medical devices rely on an adhesive interface to maintain contact with the patient. The greatest threat to on-body adhesion is mechanical stress imparted on the medical device. Several factors contribute to the ability of the device to withstand such stresses, such as the mechanical design, shape, and size of the device. This analysis investigates the impact that design changes to the device have on the stress and strain experienced by the system when acted on by a stressor. The analysis also identifies the design changes that are most effective at reducing the stress and strain. An explicit dynamic finite element analysis method was used to simulate several design iterations and a regression analysis was performed to quantify the relationship between design and resultant stress and strain. The shape, height, size, and taper of the medical device were modified, and the results indicate that, to reduce stress and strain in the system, the device should resemble a square in shape, be short in height, and small in size with a large taper. The square shape experienced 17.5% less stress compared to the next best performing shape. A 10% reduction in device height resulted in a 21% reduction in stress and 24% reduction in strain. A 20% reduction in device size caused a 7% reduction in stress and 2% reduction in strain. A 20% increase in device taper size led to a negligible reduction in stress and a 6% reduction in strain. The height of the device had the greatest impact on the resultant stress and strain.

Building towards Expertise in CME （Continuous Medical Education）： Suggestions for a New Paradigm

To build towards expertise, one has to accept to modify his way of practicing, including： （1） a need to reflect on and about the action; （2） a continuous concern about our competence to practice; （3） tireless effort to combine metacognition and mental practice in a trans-disciplinary approach; （4） adding research with neuroscience, understanding neuroplasticity, modulation and artificial intelligence. Usual practice actually does not include a continuous concern for CME （continued medical education） and is intermittent at best. This new paradigm constitutes the basis of our approach. Expertise starting in 2015 is described as an asymptotic curve unable to be obtained with usual practice and intermittent education. We suggest a new way of conceiving CME combining practice, reflection on action and in-situ simulation laboratory near work. We are describing TEE （technology-enhanced education） coupled with certain neuro-enhancers to achieve a break in the asymptotic curve of expertise. This is in reality a new conception of CME in medicine.

Experiment Combined with Picture Archiving and Communication System in the Practical Teaching of Medical Imaging

Objective:To explore the application effect of virtual simulation experiment combined with picture archiving and communication system(PACS)in medical imaging practical teaching.Methods:97 students from the medical imaging class of 2022 were divided into two groups;the control group(n=48)was taught by the traditional teaching method,whereas the research group was taught by virtual simulation experiment combined with PACS(n=49).The teaching achievements and teaching effects of the two groups were compared to define the advantages of the two teaching modes.Results:Initially,there were no significant differences in the basic theory,image analysis,report writing,and differential diagnosis scores between the two groups of students(P>0.05);however,after 16 weeks of teaching,the scores of the research group were better than those of the control group(P<0.05);the pass rate of students in the study group(93.88%)was higher than that in the control group(81.25%);the scores of students in the research group in terms of clinical inquiry skills,X-ray/computed tomography/magnetic resonance imaging(X-ray/CT/MRI)operation skills,and doctor-patient communication skills were significantly higher than those in the control group(P<0.05).Conclusion:In medical imaging practical teaching,the application of virtual simulation experiment combined with PACS can effectively address several problems in the traditional teaching mode,including the single teaching method,the single teaching content,and the lack of innovation,and,at the same time,improve students’basic theoretical knowledge,X-ray/CT/MRI operation skills,consultation skills,and doctor-patient communication skills,thereby effectively improving the teaching quality and learning effect.

Analysis of Gas Flow Rate and Pressure Loss of Medical Mask Differential Pressure Tester

The objective of this study is to find a suitable method to overcome the pressure loss problem in the gas pipe during the gas exchange detection of medical masks.Based on the European Standards EN 14683,the parameters of a medical mask differential pressure tester were selected,subsequently two schemes of gas pipe layouts were designed,including four kinds of pipe diameter which are 4,5,6.5,and 8mm respectively.Lastly,the models of each scheme were established and imported into Fluent,and the relevant parameters were set for simulation.After data analysis,the results showed that among the four different pipe diameters,the pressure loss of 8mm diameter of the pipe was lower in both the schemes,additionally the pressure loss of the second scheme(the gas pipe was short and smooth)was lower under the same pipe diameter.At the flow rate of v=8L/min,the pressure loss from the inlet to the measurement point is less than 200Pa,and the estimated measurement error is less than 1.5%.In conclusion,shortening the length of the pipe,and increasing the diameter of the pipe can reduce the gas pressure loss,subsequently improve the measurement accuracy of the medical mask differential pressure tester.