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Changes in performance during repeated in-situ simulations with different cases.

Helen Berg1, Ronald Båtnes2, Aslak Steinsbekk1

  • 1Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.

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Summary

Repeated in-situ simulations did not consistently improve clinical actions or adherence to the Airways, Breathing, Circulation, Disability, Environment/Exposure (ABCDE) approach. Healthcare teams struggled to apply learned skills to new patient cases.

Keywords:
clinical competencehigh fidelity simulationin-situ simulationinterprofessional learning

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Area of Science:

  • Medical Education
  • Patient Safety
  • Clinical Skills Training

Background:

  • Healthcare professionals require systematic approaches for managing deteriorating patients.
  • The Airways, Breathing, Circulation, Disability, Environment/Exposure (ABCDE) approach is a standardized method for patient assessment.
  • In-situ simulations offer a realistic environment for training clinical teams.

Purpose of the Study:

  • To evaluate changes in clinical performance during repeated in-situ simulations.
  • To assess the adoption of the ABCDE approach by healthcare teams with varying experience levels.
  • To determine if repeated simulations lead to improved clinical actions.

Main Methods:

  • A descriptive observational study using repeated in-situ simulations with a patient simulator.
  • Teams from a nursing home, out-of-hours general practice, and emergency department participated.
  • Blinded clinical experts assessed simulation transcripts for clinical actions and adherence to the ABCDE approach.

Main Results:

  • A lack of systematic ABCDE approach use was noted in nursing home and out-of-hours general practice teams.
  • Overall scores were highest in the first simulation and third simulation, with no clear improvement pattern.
  • Nursing home teams showed improved clinical actions in the final simulation, but other teams did not demonstrate consistent improvement.

Conclusions:

  • Repeated in-situ simulations did not yield consistent improvements in clinical actions or ABCDE approach adherence.
  • Healthcare teams did not effectively transfer learning from one case to another.
  • Further strategies are needed to enhance skill transfer and systematic approach application in clinical practice.