bluuebunny/crossref_metadata_2025_split huggingface dataset:
O significado prático de termos modais na filosofia moral kantiana
Authors: Beckenkamp Joãosinho 
Published: October 2023

Na esteira de Leibniz e da escola wolffiana, Kant seguidamente emprega termos modais como "possível" e "possibilidade" num sentido prático ou moral (quer dizer, no sentido de "lícito" ou "permitido"). Como este significado prático dos termos cumpre uma função decisiva nos argumentos que Kant desenvolve em seusÂ Princípios metafísicos da doutrina do direito, cabe explicitá-lo antes de se aventurar numa interpretação de sua doutrina do direito. No intuito de mostrar que uma semântica prática de termos modais está em uso pelo menos desde Leibniz, retoma-se sua ideia seminal e aponta-se introdutoriamente para seu desenvolvimento na lógica deôntica contemporânea. O objetivo principal deste artigo é tornar disponível a semântica envolvida para uma posterior análise dos argumentos desenvolvidos por Kant em sua doutrina do direito, em particular de sua dedução do direito de propriedade.
A56Using simulation to address staff wellbeing and retention in a global non-healthcare organization
Authors: Hamilton Carrie , Thame Anna 
Published: October 2023

Stress, anxiety and depression affect one-fifth of the working age population and are a leading cause of staff attrition and loss of productivity [1]. Conversations between colleagues can help reduce stress, increase job satisfaction and productivity, build stronger relationships, and create a more positive work environment [2]. In spite of numerous policy initiatives in large organizations and fewer in small [3], it is reported, by colleagues, that hands on ‘practice’ in having conversations would be beneficial. We were approached to create a remote live four-hour workshop with authentic simulated scenarios, appropriate for a cross cultural global reach, aiming to enable staff to feel ‘at ease’ with having proactive conversations with their colleagues on a daily basis.
In 2021-2022, 120 hours were spent developing a live module for managers working in non-healthcare environments. This module was preceded by three online eLearning modules, ‘being aware, being proactive and being responsive’. After eight pilots, content and delivery was scrutinized, analysing feedback from participating managers, facilitators, and actors. In 2023, a further 24 workshops are underway, using the refined content and delivery structure; 144 actors, 24 facilitators and 24 simulation advisers are involved. Participants are global managers, clustered into geographical regions; module timings are amended to suit time zones and in total 192 participants are able to take part in small groups of eight. A 90 minute follow up a month later enables participants to discuss the personal areas of identified focus.
Creating a safe space has been essential, with ongoing facilitator alertness. Participants have immersed themselves in the six scenarios covering loneliness, disillusion, over-work, depression, crisis and acute anxiety. Participants key areas of focus have included: being sensitive to situations, being a better observer, sharing values with staff, spending time with colleagues, scheduling time to look after oneself.
Timekeeping to ensure equity of discussion and involvement, and arrival and integration of the six actors have both been challenging, although mitigated by the pilot experience.
This programme, incorporates online eLearning modules, a remote ‘live’ simulated module, and follow-up group sessions. By practising through simulated scenarios, there is significant potential to improve the support, retention and wellbeing of employees within this non-healthcare organization. The programme’s global scope, with five regions, highlights its relevance and applicability to a diverse range of workplaces. There is potential for replication in other organizations facing similar challenges, ultimately impacting on our society as a whole.
Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A70Novel high-fidelity Surgical Simulation Educational Program (SSEP) – a systems-based approach for enhanced patient safety
Authors: Robinson Jayne , Prakesh Ajay , Foster Rachel , Rowson Mark , Bathla Sonia 
Published: October 2023

Increased pressures within the NHS, shortened learning hours and disruptions caused by the COVID-19 pandemic has significantly impacted surgical training. Current courses focus on single training levels, but errors occur through systemwide failures [1]. We developed a SSEP targeting cross specialty and team-based patient management, focused on clinical knowledge and skills, cognitive simulation, leadership and human factors based upon real life events to optimize training in a system that lacks time and exposure.
A six-month pilot program was designed with monthly sessions, attended by surgical nurses, junior doctors and consultants, covering common surgical scenarios mapped to the ISCP curriculum [2], and topics highlighted through local clinical governance. Immersive interactive sessions were delivered by a dedicated consultant led education team to provide a mixed reality environment for each simulated scenario. Faculty encompassed emergency, anaesthetic and surgical consultants to facilitate realistic multidisciplinary team working. The professional identity and grade of participants were maintained during each simulation to ensure sessions were representative of real-life events with a clear mutual goal to improve knowledge and skills to transpose into safer patient care at all levels of seniority. Sessions combined simulated scenarios with structured teaching, clear learning objectives, detailed peer feedback and opportunity for juniors to complete work-based assessments with consultants. Senior trainees benefited from participation in the design and delivery of sessions providing opportunities to strengthen their leadership skills. We recorded participants pre- and post-simulation confidence, and knowledge, were measured using 5-point Likert scale feedback forms, and multiple-choice questionnaire (MCQ) paper respectively.
Two-paired T analysis showed statistically significant improvements in participant confidence across all 4 simulations (
Pooled two-paired T-Test analysis of participant self-rated confidence, in managing clinical scenarios and core topics, before and after participation in 4 high-fidelity simulated scenarios, at the 95% confidence interval (*Significance α = ≤0.05).
Our SSEP is an effective strategy for the improvement of trainees’ confidence and knowledge in managing challenging surgical scenarios, which actively contributes to the development of skills for clinical practice. Evaluation of long-term knowledge retention is necessary. Our ambition is to develop the program as a quality improvement project (QIP) that implements learning from significant events and demonstrate improved outcomes in these domains. We endeavour to embed this simulation training across the region.
Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A109A simulation escape room: Does gameful training promote active learning and student engagement
Authors: Morgan Lucy 
Published: October 2023

Gamification of learning is becoming increasingly popular within higher education [1]. Student activities described as ‘gameful training’, including Escape Rooms, have reported additional learner benefits including improved teamwork, creative thinking and communication skills compared to traditional session designs [2]. There is a small number of existing case studies demonstrating their utilization within healthcare professional education and the reported additional benefits included pertinent skills such as task delegation and leadership, as well as being an engaging teaching strategy that promotes active learning [3].
A trial simulation escape room was created and implemented for level 5 adult and mental health branch nursing students within a Higher Education Institution. 12 different teams of students entered the escape room and worked together to ‘treat Arthur’, a patient presenting with acute anxiety and chest pain. Students were required to assess, escalate and manage Arthur effectively and would ‘escape the ward’, once he had received all of the required treatment.
The learning outcomes for the scenario and subsequent puzzles and tasks were created based on recent curriculum teaching allowing students to apply prior learning within the escape room environment. Puzzles included coded locked boxes and students were required to apply relevant knowledge, such as answering pharmacology questions, to generate codes and progress throughout the scenario. Simulation equipment was utilized and students unlocked clinical treatments and medical devices which in turn had to be delivered to Arthur. The facilitator maintained an active role within the scenario and allowed students to practise communication skills such as escalating their concerns about Arthur via the telephone.
It must be noted that the design time was significant for one scenario and required several pilots to ensure that all components were cohesive. Full support and creative input was required from the simulation technicians to ensure the activity’s success.
Students fed back that they enjoyed the activity and were observed to work effectively together and prioritize and delegate throughout the task with minimal supervision. Students also stated the scenario context was helpful to apply their prior learning and were pleased that they had been able to manage this patient presentation together. Feedback from facilitators was also positive and both staff and students found it to be an engaging experience.
Simulation escape rooms offer an innovative and engaging way for students to apply learning and vital practice technical and non-technical skills. For educators, clear learning outcomes and allowing sufficient design time is a necessity.
Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A93Addressing patient-safety themes and fostering cohesive teamwork through weekly multidisciplinary in-situ simulation in an Acute Care Unit
Authors: Ziegler Joseph , Stevens Lisa 
Published: October 2023

The Acute Care Unit (ACU) is the busy admissions ward at the trust. Many junior doctors rotate through the ACU for their acute medicine training and the department frequently welcomes newly-qualified nurses or nurses new to the NHS. All staff are involved in managing acutely unwell admissions with a range of presentations.
In this dynamic environment, ensuring time is dedicated to teaching is an important part of staff development. In addition, it is important to create opportunities for team-building between disciplines, and evidence shows that this improves outcomes for patients [1].
Teaching for different professional disciplines is often delivered separately. Whilst sometimes preferable, we recognized the department could benefit from simulation sessions involving all members of the clinical team to represent realistic clinical practice. The aims were to:

Address recent clinical incidents
Practice managing common medical emergencies as a multidisciplinary team
Build a greater sense of team between the ACU staff.
We designed and implemented a programme of weekly multidisciplinary in-situ simulation on ACU. Sessions involve a range of nursing and medical staff and students and are delivered in an empty bed space on the ACU. Simulations focus on clinical scenarios that might reasonably arise in the department. We use iSimulate technology and re-use the simulation suite’s equipment to reduce resource burden and maintain sustainability.
Feedback is collected after each session to quality assure and improve the sessions, and 2 further quality improvement reviews completed to explore how to maximize engagement and learning. This has led to coordination of scenarios with the established weekly seminar-based departmental teaching, to consolidate learning across settings and this is reinforced with a ‘learning point of the week’.
Sessions have been successfully delivered on a near-weekly basis throughout the year, despite significant clinical pressures. This has been achieved through coordinated efforts from the simulation team, ACU fellows and registrars, charge nurses and Practice Development Nurse.
We estimate to have reached more than 50 colleagues, with typically 4-8 attendees per session. We have rotated through 15 different scenarios and counting, covering key topics including various medical emergencies, violence and aggression, and ‘soft signs’ of deterioration.
The programme has been well received, and feedback has specifically commented on the benefit of simulation in a multidisciplinary and in-situ setting.
We demonstrate it is possible to maintain an effective regular simulation programme in the department to support patient safety initiatives and team working.
Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A81Advance Choice Documents: a Simulation for Service Users, Carers and Clinicians
Authors: Fisher Megan , Bignell Anita , Schilderman Marcela , Henderson Claire , Smith Shubulade , Babatunde Abigail , Galloway Selena , Ruiz Mariola 
Published: October 2023

Advance Choice Documents (ACDs) are one of the important upcoming reforms to the Mental Health Act in the UK [1]. The aim of the document is to allow service users greater autonomy when they are well, to make decisions and guide what happens if they become unwell in the future. It is created by a service user and clinician in a shared decision-making process.
Maudsley Learning (ML) collaborated with an Institute of Psychiatry, Psychology and Neuroscience research team to provide a co-produced simulation day for service users, carers and clinicians. The aim was for participants to be able to gain a greater understanding of how to co-produce and implement ACDs.
ML ran two separate simulation days, alongside, members of the research team including a lawyer and facilitator with lived experience.
The initial part of the day included didactic teaching; allowing participants to learn more about ACDs and have a space to ask questions from those with lived experience, clinicians and lawyers. This ensured participants gained a baseline level of knowledge to undertake the scenarios.
There were four simulation scenarios written, but only three took place on both days because of limited time. These revolved around one patient; the participants followed the patient through their ACD journey. The patient was played by an actor. All scenarios were designed to involve a clinician, often with the presence of a carer and service user as well.
The debrief consisted of a modified Pendleton model with feedback from service user, carers and clinicians to allow feedback and learning from all involved.
Participants were asked to complete a pre-course and post-course questionnaire. Paired samples t-tests were conducted to analyse the difference between pre- and post-course questionnaires. Results demonstrated a significant difference in scores for course-specific questions between the pre (M = 3.17, SD = 0.81) and post (M = 4.21, SD = 0.20), t(5) = -5.26, p <.05, 95% CI [-1.55, -0.53], with a large effect size of d = -2.15. 100% of participants would recommend this course.
This was the first simulation that ML has run with a mixed group of learners that included not only clinicians, but also service users and carers taking part in the simulation and debrief. The feedback was positive and helped to improve the knowledge around ACD’s. It was also noticeable the positive difference it made having clinicians, service users and carers learning from one another.
Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A92Sustained Quality in Simulation Training – ‘Step-Up’ to IMT3
Authors: Carnall Lia , Edward Roy , Atkinson Ben 
Published: October 2023

Following the introduction of the ‘IMT3’ year as part of Internal Medicine Training in 2019, a ‘Step-Up’ simulation day was developed in 2021. Positive feedback from candidates reflected its usefulness in preparing to work as a medical registrar [1]. The scenarios were conducted with the subsequent cohort of IMT3 doctors and feedback assessed for sustained quality of training.
Simulation is recognized as an important tool in medical education [2]. It is now specified by the Royal College of Physicians that trainees participate in simulation inclusive of human factors and scenario training [3].
The ‘Step-Up’ simulation day continues to consist of four progressive, high-fidelity scenarios that replicate a day in the life of a medical registrar. Each scenario occurs in the simulation lab for individual candidates, with peers observing via video-link in the debrief room.
Each scenario requires the candidate to perform a medical assessment of an acutely unwell patient, facilitated by use of the computerized manikin (SimMan Essential), whilst simultaneously tackling difficult conversations with a live actor and managing interruptions from a bleep. Participants also had the opportunity to lead simulated cardiac arrests with peers forming the cardiac arrest team.
Debrief and teaching continued to be provided by a qualified simulation facilitator alongside a specialist registrar or consultant. Feedback provision was moved to an online format and accessed via a QR code to be more environmentally conscious and to readily allow analysis and storage for future comparison. In order to assess sustained quality, the same five aspects of the day were assessed by participants on a ten-point Likert scale: relevance, pitch, clarity, usefulness and overall quality. Scores of 1 reflected strong disagreement and 10 of strong agreement. Free text feedback allowed candidates to suggest topics for future sessions or identify valuable learning points.
Thirteen IMT3 or equivalent doctors participated in this round of ‘Step-Up’ simulation with 100% feedback rate. As in previous rounds median and modal scores were 10 in all 5 domains, ranging from 7 to 10. Free text feedback recorded multiple requests for further simulation sessions.
‘Step-Up’ simulation was demonstrated previously to be a useful tool in progression to IMT3. Overall quality and usefulness were sustained year-on-year and simulated challenging discussions were highly valued by participants.
Therefore, this programme will continue for future cohorts, with ongoing monitoring of sustained quality and development of new scenarios to provide increased frequency of simulation training.
Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A69Sustain and Spread: A Standardized Solution for High Quality Simulation
Authors: Damberg Kristine , Blair Jennifer , Wadsworth Jessica , Millett Ruth , Esposito Maria , van Vuren Eloise , Hassan Sumair 
Published: October 2023

The past three years during Covid19 have brought significant changes to our simulation service, including a change of specialist extended faculty. As we began to resume our standard service, and new faculty members joined the team, it became apparent that we had been heavily reliant on individual faculty memory and had lost some organizational memory. This impacted the efficiency and quality of the service, as well as the experience for the new staff members. Therefore, we decided to evaluate all our courses to identify opportunities that would improve the overall service and help integrate new faculty.
We initially used a scoping exercise based on the System Engineering Initiative in Patient Safety (SEIPS) framework [1] to evaluate all our courses looking at course design, scenario design, evaluation tools and course delivery to highlight themes for service improvement. Potential service improvement ideas were prioritized taking into consideration the Hierarchy of Intervention Effectiveness to ensure improvements were mixed across the person and system-focused levels [2].
The SEIPS scoping exercise highlighted inconsistency in course design, delivery and evaluation. As a team we set about designing a standardized approach that could be applied to both established and new courses, aiming to enable course resilience and retain valuable knowledge and documentation.
We have designed and embedded standardization in all aspects of course design, delivery and evaluation:

SEIPS based scenario design proforma
Course introduction with a human factors workshop
Incivility workshop
Technical teaching aid for debriefing
Human factors teaching tools
Pre- and post-course evaluation
Anonymized feedback from faculty was used to assess the impact of the standardized course design. This standardized approach has supported existing and new faculty to develop and run high quality courses; created a shared understanding of teaching content and delivery, and has had a positive impact on the consistency of course quality.
By scoping and exploring our service we illuminated gaps within our organizational memory and were able to strengthen these by designing a series of innovative documents, proformas, teaching aides and evaluation. This standardized approach helps to enable consistent high quality, support new faculty, whilst still allowing for flexibility and adaptations when delivering courses.
Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.