Programs of Research in Healthcare Simulation

The publications that relate to the application of simulation to healthcare have steadily increased over the years. These publications are scattered amongst various journals that belong to several subject categories, including operational research, health economics and pharmacokinetics. The simulation techniques that are applied to the study of healthcare problems are also various. The aim of this study, therefore, is to review healthcare simulation literature that have been published between 1970 and 2007 in high-quality journals belonging to various subject categories and that report on the application of four simulation techniques, namely, Monte Carlo simulation, discrete-event simulation, system dynamics and agent-based simulation. Arguably, journal impact factor is fundamental in assessing the quality of publications. Thus, the 201 publications selected for review have been queried from the ISI Web of Science® bibliographic database of high-impact research journals. Through a review of healthcare simulation literature the following three objectives have been realized: (a) papers have been categorized under the different simulation techniques, and the healthcare problems that each technique is employed to investigate are identified; (b) variables such as authors, article citations, etc., within our dataset of healthcare papers have been profiled; (c) turning point (strategically important) papers and authors have been identified through co-citation analysis of references cited by the papers in our dataset. The above objectives have been realized by devising and then employing a methodology for profiling literature. It is expected that this review paper will help the readers gain a broader understanding of research in healthcare simulation.

Presently, health care simulation research is largely conducted on a study-by-study basis. Although such "project-based" research generates a plethora of evidence, it can be chaotic and contradictory. A move toward sustained, thematic, theory-based programs of research is necessary to advance knowledge in the field. Recognizing that simulation is a complex intervention, we present a framework for developing research programs in simulation-based education adapted from the Medical Research Council (MRC) guidance. This framework calls for an iterative approach to developing, refining, evaluating, and implementing simulation interventions. The adapted framework guidance emphasizes: (1) identification of theory and existing evidence; (2) modeling and piloting interventions to clarify active ingredients and identify mechanisms linking the context, intervention, and outcomes; and (3) evaluation of intervention processes and outcomes in both the laboratory and real-world setting. The proposed framework will aid simulation researchers in developing more robust interventions that optimize simulation-based education and advance our understanding of simulation pedagogy.

BACKGROUND AND PURPOSESimulation is an established method for building knowledge and ensuring competence in the aviation industry and military training.1 Health care simulation has been widely adopted in medical and nursing education with simulated experiences emerging in program accreditation requirements. Simulation is growing in use for health care staff development, including using simulations in the providers' practice environment. Physical therapy education has a long tradition of simulations, using standardized patients and role playing.25 Interprofessional and mannequinbased simulation in physical therapy education is a growing in popularity.68 Research in health care simulation consistently reveals the importance of sound debriefing strategies to realize the desired learning objectives.9,10In part, health care simulation has been driven by the increasing sensitivity and attention to inherent risk to patients posed by novice and inexperienced health care providers. Clinical training of physical therapy students is challenged by declining availability of clinical educational experiences and stipulations requiring close supervision of students.11,12 Clinical education cannot be scripted to present the range of situations that prompt the safe execution of skills and decision-making that a physical therapist (PT) must possess. Simulation can introduce the high risk/low frequency clinical events or highly sensitive patient interactions that have low tolerance for error within a learning experience that does not impose risk to actual patients. Furthermore, simulation allows feedback and repetition of events to achieve mastery. This practice can be aided by temporal manipulation of the experience with use of pause to think, rewind to a critical point, or a do-over following a suboptimal performance. Within clinical practice, simulation can also be a risk management strategy to revisit a breakdown of care, evaluate a near miss event, or rehearse a new workflow process.13 Simulation is particularly useful for developing team functioning.14Growing use of simulation in physical therapy education and professional development calls for an evidence-based approach. Best simulation practices require experiences purposely designed to expose the learner's frameworks, the cognitive foundation that directs clinical decisions and actions.15 Research in health care simulation has established essential conditions to create an effective learning environment. Simulation in medical education has demonstrated the importance of supporting realism, using prompts, effectively using confederates, and scripting key elements of the simulation. The key piece to participant learning is postsimulation debriefing, methods that serve to uncover and shape decision frame works. Ideally, a simulation is purposefully designed to expose any decision errors or performance gaps, which can then lend to fruitful debriefing. Various debriefing tools that have been developed and researched can be translated to physical therapy simulation. Evidenced-based simulation and debriefing strategies have the potential to sharpen skills and transform the learner's decision frameworks, which leads to durable improvements in clinical knowledge and competency.The purpose of this perspective is to justify the integration of simulation in physical therapy education and professional development. Simulation grounded in an evidence-based, pedagogical approach is a powerful learning tool independent of the technology available. The perspective will offer strategies, tools, and scripts that physical therapy educators can apply to their own simulations, leading to positive learning outcomes and replacing traditional instructional methods. Furthermore, simulation can support professional development for practicing PTs.POSITIONDespite its recognized value, the pedagogy and learning theory that supports simulation and debriefing is often overshadowed by simulation technology. …

In contrast to qualitative research, quantitative research focuses primarily on the testing of hypotheses using variables that are measured numerically and analyzed using statistical procedures. If appropriately designed, quantitative approaches provide the ability to establish causal relationships between variables. Hypothesis testing is a critical component of quantitative methods, and requires appropriately framed research questions, knowledge of the appropriate literature, and guidance from relevant theoretical frameworks. Within the field of simulation, two broad categories of quantitative research exist: studies that investigate the use of simulation as a variable and studies using simulation to investigate other questions and issues. In this chapter we review common study designs and introduce some key concepts pertaining to measurement and statistical analysis. We conclude the chapter with a survey of common errors in quantitative study design and implementation.

Studies in healthcare simulation research are often based on performance scores. These scores can be used to compare provider groups, establish the efficacy of competing educational programs, and identify clinical skills deficiencies. The following chapter provides an overview of the development and use of assessment tools. Researchers need to select tools that align with the purpose of the assessment. Where human evaluators are employed, they should have sufficient expertise in the domains being assessed. Training is also necessary to ensure that evaluators are using the rubrics as intended. In the future, technology may be helpful for gathering accurate data from, and providing standardized scoring for, various simulation-based assessments. Healthcare simulation researchers who employ assessment tools need to evaluate whether the scores that are produced represent reliable and valid estimates of ability. Without some assurance of the psychometric rigor of the scores, their use in any research study could be questioned.

Publication in peer-reviewed journals, and serving on editorial boards, is considered an indicator of academic productivity and success, and a means of influencing discourse and practice in a field. This bibliometric review explored gender in authorship, and editorship, across the 3 existing English language, nonspecialty specific healthcare simulation journals. In total, 40.4% of publications had women first authors and 34.4% had women senior authors. There were no differences by journal and no apparent changes over time. Poor participation of women on editorial boards (38.1% of editorial board members were women) was observed. The observed level of representation of women as first and senior authors, and on editorial boards, is comparable with other health sciences domains but nonetheless warrants attention and improvement. Future research examining the profile of those working within simulation or evaluating strategies to improve the participation of women within healthcare simulation research and journals would be of interest.

There are many frameworks available that can guide the researcher through the process of project management for simulation research. Projects are not routine business, but are a unique specified set of operations designed to accomplish specified goals. In the context of simulation research, the overarching goal is usually to answer a discrete research question. Projects therefore frequently bring together a team of people and stakeholders, who do not usually work together, and are often from different organizations, different career backgrounds, and across multiple geographical sites. This chapter explores the components of common key frameworks. Sequentially to a project management framework is the need for risk mitigation strategies to ensure smooth running of your project. Piloting your project can help identify many of the challenges you may face during the project. There are also many risks that are specific to simulation research. Many of these risks can be avoided with careful planning, attempting to manage the unmanageable, and the development of detailed timelines and budgets that are specific to research projects.

The Society for Simulation in Healthcare held its third research summit in January 2023 with the aim of establishing evidence-based guidelines for healthcare simulation training. A panel of researchers, clinicians, and subject-matter experts conducted reviews of the literature addressing 12 key topics and followed a formal process to generate 16 guidelines for simulation-based training in healthcare. Eleven peer-reviewed literature reviews accompany these guidelines. Over the last 12 years, the Society for Simulation in Healthcare research summits have evolved with a consistent aim to advance simulation research, culminating in the formal set of guidelines published in this special issue.

IntroductionTeam mental models and team situational awareness are key components of healthcare team simulation. Human factors and organizational psychology researchers have developed clear definitions and theories about these concepts that are at times ‘lost in translation’ within the prevailing forms of measurement and training utilized in healthcare. Simulation research to date has often relied upon indirect and imprecise measures and a conceptualization of team cognition that ill equips simulation educators as they endeavour to optimize healthcare team performance.MethodsWe present a narrative review that examines how team cognition is assessed in healthcare team simulation, critically consider assessment strategies described in key studies, and contrast them to advances in human factors and organizational psychology.ResultsThis study presents a framework that reconceptualizes how we measure team cognition in healthcare simulation along the matrices of directness and timing of evaluation. We pair this framework with a table that exemplifies extant measurement techniques and highlight how simulation educators may decide between different ‘types’ of assessment based upon their needs.DiscussionWe offer recommendations for educators to consider capturing team cognition before, during, and after simulation. We also offer recommendations for researchers to develop tools that may be more readily applied across key settings.ConclusionHere, we present a framework of team cognition for healthcare action teams that advances healthcare simulation to better align with human factors and organizational psychology literature. This work will guide healthcare simulation educators and researchers on their quest to optimize team performance through improved team cognition.Trial registrationNone.

Collaborations between researchers and practitioners have recently become increasingly popular in education, and educational design research (EDR) may benefit greatly from investigating such partnerships. One important domain in which EDR on collaborations between researchers and practitioners can be applied is research on simulation-based learning. However, frameworks describing both research and design processes in research programs on simulation-based learning are currently lacking. The framework proposed in this paper addresses this research gap. It is derived from theory and delineates levels, phases, activities, roles, and products of research programs to develop simulations as complex scientific artifacts for research purposes. This dual-level framework applies to research programs with a research committee and multiple subordinate research projects. The proposed framework is illustrated by examples from the actual research and design process of an interdisciplinary research program investigating the facilitation of diagnostic competences through instructional support in simulations. On a theoretical level, the framework contributes primarily to the literature of EDR by offering a unique dual-level perspective. Moreover, on a practical level, the framework may help by providing recommendations to guide the research and design process in research programs.

Background: Simulation in healthcare lacks a dedicated framework and supporting taxonomy for instructional design (ID) to assist educators in creating appropriate simulation learning experiences.Aims: This article aims to fill the identified gap. It provides a conceptual framework for ID of healthcare simulation.Methods: The work is based on published literature and authors’ experience with simulation-based education.Results: The framework for ID itself presents four progressive levels describing the educational intervention. Medium is the mode of delivery of instruction. Simulation modality is the broad description of the simulation experience and includes four modalities (computer-based simulation, simulated patient (SP), simulated clinical immersion, and procedural simulation) in addition to mixed, hybrid simulations. Instructional method describes the techniques used for learning. Presentation describes the detailed characteristics of the intervention.The choice of simulation as a learning medium is based on a matrix of simulation relating acuity (severity) to opportunity (frequency) of events, with a corresponding zone of simulation. An accompanying chart assists in the selection of appropriate media and simulation modalities based on learning outcomes.Conclusion: This framework should help educators incorporate simulation in their ID efforts. It also provides a taxonomy to streamline future research and ID efforts in simulation.

To look toward the future of genomics research and identify genomic-based resources and opportunities for nurse scientists to incorporate genomic concepts into their programs of research. Five research themes for the future, developed by the National Institute of Nursing Research in collaboration with nurse scientists, are the framework for this article: (a) changing lifestyle behaviors for better health; (b) managing the effects of chronic illness to improve health and quality of life; (c) identifying effective strategies to reduce health disparities; (d) harnessing advanced technologies to serve human needs; and (e) enhancing end-of-life experiences for patients and their families. Nurse scientists around the world are increasingly integrating genomics into their programs of research. Emerging international genomic initiatives, discoveries, and resources will provide rich opportunities for nurse scientists, as members of interdisciplinary teams, to address important biological, behavioral, social, and ethical questions. This evolving genomic nursing science will be necessary in practice, education, and policy in a time when rapid genomic discoveries are occurring.

Onward and Upward: Introducing the Healthcare Simulation Standards of Best PracticeTM

Commentary

School, family and the community constitute three distinct but at the same time interdependent systems. The ideas, notions and research which are related to the necessity of the functional communication of those systems have recently flourished internationally, creating a substantial “heritage” in principles, acceptances, theoretical models, application proposals, research programs as well as new orientations and perspectives. This paper proposes the model of syneducation. As syneducation (synergy + education) we define the acquisition of a common educational experience, simultaneously and in cooperation, of persons differing in age and cognitive infrastructure and often in social and cultural level. Syneducation is a new emerging research field. With its application, we aim at the change of attitudes and behaviours of the participants (parents, educators, students, policy makers and the representatives of the community) from an initial state of possible indifference- disinterest to an active and effective participation in common syneducational actions in order to face specific issues, and even further to being multipliers of the above mentioned actions. Furthermore, the application of this model creates, develops and accrues social capital.In this paper we will present certain research applications which took place according to the model of syneducation based on the methodology of collaborative action research (for example, a transdisciplinary research program, a research program in Literacy in Information Technology, a research program focusing on problem management within the family etc.) The research findings and the prospects of the syneducation model are still being discussed. This model is proposed as a realistic way of thought and action adapted to the contemporary conditions of our technological era and the foreseen needs of social computing.