bluuebunny/crossref_metadata_2025_split huggingface dataset:
72 Medical Student Attitudes Towards Point-of-Care Ultrasound in Undergraduate Medical Education
Authors: Karp John , Voborsky Miroslav , Woodward Christopher , McDermott Cian , Kirrane Rebecca , Gilmore Rachel , Condron Claire 
Published: January 2022

Point-of-care ultrasound (PoCUS) is a bedside imaging modality that provides the operator with instant clinical patient information. PoCUS is a low-cost, radiation-free, portable diagnostic tool that is utilized in many specialities The aim of the study was to assess undergraduate medical students’ attitudes towards PoCUS through the implementation of a rudimentary proctored PoCUS workshop.Third-year medical students at the Royal College of Surgeons in Ireland participated in a 1-hour PoCUS workshop as part of their fundamental clinical skills training. Medical students attended the in-person workshop repeated over 8 weeks. Students were exposed to three ultrasound stations. The first was a CAE Vimedix ultrasound simulator utilizing augmented reality colourization and 3D modelling. The second station was learning and performing an extended FAST scan with a focus on bright mode image acquisition and free fluid recognition. The third station was the practical placement of peripheral/central IV-line insertion helping students to identify vasculature while also manipulating the ultrasound transducer as a procedural adjunct. Students were asked to complete a post-workshop survey to investigate their attitudes towards ultrasound teaching in undergraduate medical education. The survey consisted of 10 questions to assess attendee’s prior ultrasound knowledge, to provide constructive feedback regarding the workshop and how ultrasound can be incorporated into future undergraduate medical education.A total of 121 students completed the post-workshop survey. Of those who completed the survey, 94.2% of students had never used an ultrasound machine before and 100% had never performed PoCUS previously. Collectively, participants strongly agreed 100% that PoCUS should be incorporated into the undergraduate medical student curriculum at RCSI. In particular, 89.3% and 45.5% of students indicated that POTUS should be included in the third- and fourth-year medicine curriculum, respectively. 85.1% of students indicated that PoCUS education would be most valuable to supplement clinical placement followed by anatomy (62.8%), pathology (59.9%) and physiology (23.1%). 86.8% of the students were interested in learning more about PoCUS through an online format.PoCUS appears to be an additional valuable learning resource for undergraduate medical students. Of the students surveyed, it is apparent that there is strong support in favour of early ultrasound integration into the future medical school curriculum.
113 Making Virtual a Reality During a Pandemic: Improving Learning Opportunities in Medical Education through Virtual Reality Simulation
Authors: Shiels Sally , Irvine Amy , Flaherty Sarah , Higham Helen 
Published: January 2022

William Osler was the first to be credited with taking medical students out of the lecture theatre and to the bedside Could VRS provide a meaningful learning opportunity during the first wave? Could we elicit the strengths and weaknesses of virtual simulation in medical learning?We used the Oxford Medical Simulation (oxfordmedicalsimulation.com) VRS platform where the learner manages an acutely unwell patient with specified learning objectives (opting for the 2-D to make it accessible to students at home). Scenarios were grouped, accompanied by didactic learning resources and released on a weekly schedule. Data were collected with consent on the number of scenarios accessed, performance score and student feedback.The VRS course ran for 5 weeks (access extended to 11 weeks). In total, 224 students expressed an interest in accessing the VRS platform. Of the 224 students, 64 accessed the scenarios (50% first-year students). The students accessed 821 scenarios. The average score on all first attempts of scenarios was 75%; second attempts 78% and third attempts 90% (The high initial response rate suggested student interest and engagement. The low (21%) conversion rate to accessing the VRS platform may be explained by initial technical issues and the voluntary nature of the project. The quantitative data show the importance of repetition in improving learning. Participation over time may improve with incorporation into the medical school curriculum. Lower usage among the final-year medical students may be explained by volunteering and early commencement of clinical duties. This innovation reveals some strengths of VRS: basic equipment; learner-directed; improved performance and student interest. Overall, the VRS platform allowed the delivery of a rapid response to fill a gap in clinical education. The next phase of this project will be to provide live tutor-supported debrief.
121 The Rapid Infuser Challenge: Applying Gamification to Improve Performance
Authors: Smith Matthew , Atkinson Ben , Pughe George 
Published: January 2022

Major haemorrhage causes systemic shock with resultant coagulopathy. The Belmont Rapid Infuser© (BRI) is one example of a rapid infuser device to deliver intravenous fluids and blood products to patients as part of emergency resuscitation. We are a simulation team based in a busy trauma unit and anecdotally our staff did not feel confident in using our BRI.
We aimed to quantify how confident our nursing staff were in using the BRI, before and after delivering a simulated patient scenario asking them to transfuse blood products using the BRI. We also aimed to quantify whether a simulated scenario could reduce the time taken to use the BRI. We aimed to create an enjoyable environment and use aspects of gamification
A self-evaluation questionnaire was circulated to establish pre-scenario confidence. Candidates observed a demonstration of the set-up and use of the BRI. Candidates were read a scenario brief and asked to use the BRI to infuse 500 ml of simulated blood product at 200 ml/minute. Once they had completed the scenario, their time was recorded, they were asked to again self-evaluate their confidence and were invited to attend again at a later date to ‘compete’ against their previous time.
Pre-scenario data confirmed what was suspected; there was a wide variation in confidence in using the BRI across the sample. Early data suggest that the simulation was able to significantly increase staff confidence in safely using the BRI and repeated attempts led to a significant reduction in time to safely transfuse.
Positive participant feedback included recommendations for further hands-on deliberate practice. We hope the training can be expanded to also include members of the medical team. Further research is needed to explore the use of gamification to support simulation-based medical education within urgent care.
90 COVID-19 Simulation Programme: Rapid Tests of Change
Authors: Cooper Angus , Morse Jeremy , Brown Craig 
Published: January 2022

The ‘first wave’ of COVID-19 created many challenges. Our hospital was fortunate to have slightly longer than many others to prepare. One of our Emergency Department (ED) challenges was that, as part of a redesigned process, patients with respiratory failure (presumed COVID-19) were to be assessed in a very different clinical area (single rooms instead of ‘open plan’ resuscitation room), managed by a much larger team of clinicians, using Level 3 (airborne) PPE and a modified approach to Rapid Sequence Intubation (RSI) induction of anaesthesia. Rapid cycle simulation and debrief has subsequently been described as part of a system-based learning approach during the COVID-19 pandemic The aim of this programme was to rapidly familiarize a large team with the new clinical environment and RSI process, using the learning conversation after each simulation to make an immediate change, as required, to the clinical area and/or process.Each simulation was an identical clinical scenario, i.e. a patient with respiratory distress for whom the need for COVID-19 modified RSI had been identified. The simulation was delivered in the rooms that were subsequently to be used for direct clinical care of confirmed or suspected COVID-19 patients.A process testing approach was taken. During the simulation brief, the process was talked through in detail (all expected actions and sequence), the team then performed the simulation, followed by a learning conversation that was very focussed on the challenges in delivering this process. Using mobile cameras and large screen TV, all simulations were live streamed to an immediately adjacent area, such that a large number of other clinicians could observe the brief, the simulated clinical scenario and participate in the learning conversation. Agreed changes in equipment, ergonomics and process were immediately incorporated into the next simulation. Once this area was required for direct patient care, an identical room was set up in an adjacent (non-COVID-19 clinical area) to allow daily simulated training to continue. On one occasion, where there was advance notice of the arrival of a patient requiring RSI, the team who were to be involved in the RSI ‘drilled’ this scenario (‘just in time’ simulation) whilst awaiting the arrival of the patient. It was observed that participants who had previously been less comfortable with simulation were happier with this process testing approach (knowing what is expected and with no surprises).
123 Tint: Training in Trauma Simulation Programme
Authors: Jaffar Farah , Khan Salman , Westlake Harley , Malhan Neeraj 
Published: January 2022

Major trauma is one of the leading contributors to death for several age groups globally making it a public health concern. There are approximately 20,000 cases of major trauma per year in England and over 25% of these result in deaths This Emergency Medicine (EM) course was designed for Specialty and Associate Specialist Grade (SASG) doctors to develop leadership skills and to demonstrate technical and non-technical skills as a trauma team leader (TTL) when assessing severely injured patients. This course has a strong focus on the understanding of hospital systems and processes for the timely assessment and treatment of complex trauma patients.After a successful HEE funding bid, a simulation training course was devised to cover the main principles of trauma management and the non-technical skills required to manage a trauma patient and help up-skill the 14 SASG doctors at an urban trauma unit. Five scenarios were designed based on real patients seen in urban trauma units in London. On designing the scenarios, an understanding of the functioning of hospital systems such as requesting and administering blood products and transferring patients both within the hospital and within the trauma network, were crucial learning objectives.This course was delivered weekly from January to June 2021. Sessions involved the EM SASG doctor, two EM nurses and the members of the wider MDT expected at each trauma call, to recreate the resuscitation room environment. Each SASG doctor underwent all five trauma simulation scenarios individually as the TTL. Each scenario was followed by a focussed debrief by two EM consultants, with discussion around human factors, technical and academic aspects of trauma management. All 14 SASG doctors completed the five trauma scenarios. As a result of this training, there has been an improvement in the management of patients with higher injury severity scores in the ED based on both clinical supervision and feedback from the candidates. Given the impact on practice that this training has had, this course will be delivered to the wider trauma teams within the trust, with the EM SASG doctors continuing as TTLs.
65 Putting it into Practice: A Simulation-Based Education Programme for Parents
Authors: Smith Jessica , Tyer Abigail 
Published: January 2022

The Paediatric Long-Term Ventilation (LTV) team are increasingly discharging children home with LTV via a tracheostomy. As a result, more parents are being asked to play the role of a nurse. They receive training, prior to discharge, in highly skilled tasks to enable them to care for their child’s long-term health needs at home. Whilst Simulation-based Education (SBE) is widely used in the education of health professionals, it is not currently part of the educational programme for these parents/caregivers.The aim of the study was to undertake a quality improvement project to produce an SBE programme for parents/caregivers of children being discharged home on LTV via a tracheostomy. The main objective was to improve the safety of patients through improving the confidence of parents/caregivers in managing and escalating emergencies prior to their discharge.Through a focus group including parents/caregivers of children receiving LTV via a tracheostomy, who are already at home, we aim to co-produce this project, with the patient voice and experiences at its core. We plan to undertake the SBE with one or more parents/caregivers in a location separate from the clinical setting, that is designed to replicate their home environment as best as possible Over the next 4 months, baseline data will be collected with a Likert scale of confidence ratings for each of the planned scenarios, prior to the SBE. We will collect these data again immediately after the SBE, and then again at 3 months. We will also ask, at both of these time points, if there is anything additional that the parents/caregivers would have wanted from the SBE and how it can be improved. These data will allow us to evaluate and develop the programme for future families through a plan-do-study-act cycle approach. To understand where SBE fits within the wider education provided to parents/caregivers, we will ask them which elements of their education they have found most useful, and why.
7 Covid-19 Vaccination Clinic Experience: Using Simulation to Create and Test Systems
Authors: Garland Lynn 
Published: January 2022

In November 2020, the first COVID-19 vaccine for the UK had been approved. We were subsequently tasked with the rapid development of vaccination clinics. Two COVID-19 vaccination clinics in suitable spaces within the University Hospitals Bristol and Weston NHS Ft were planned, across two different hospital sites (25 miles apart), to be operational within 7 days. Changes to both pharmaceutical and national guidelines were altering by the hour.The key driver for this fast-paced change was to ensure vaccines were delivered as soon as available to Bristol-based health and social care staff.A process map outlining the vaccination journey established in the local public vaccination site was the starting point to understand how to efficiently, effectively and safely deliver vaccines. Hospital sites for both clinics were identified, and work began immediately to vacate those rooms and establish both the infrastructure and personnel to run the large-scale clinics. Simulation Lead Educator involvement during the first days of planning was essential and at each stage of the process mapping.Simulation Round 1:
full-scale simulated vaccine clinic in the newly designed rooms on one sitestandardized patients (actors) briefed as receiving the simulated vaccinekey staff in roles – administrators, pharmacy, vaccinatorsdebrief focussed on latent threats, agreeing immediate changes to be tested in the next roundpatient experience feedback from the standardized patientsSimulation round 2:
immediate re-run of the simulated clinicsolutions identified in Round 1 were applied and testedrapid improvements to the process mapping, ergonomics, clarity of roles and timings for clinic appointments were able to be madeSimulation round 3:
Round 3 took place on the second site a few days laterlessons learnt from the first two stages being shared and translated within the new siteessential safety and efficiency issues were explored and lessons learnt applied to the clinicThe three rounds of simulation systems testing identified a number of latent threats and process mapping alterations which were implemented immediately, with solutions being tested on the spot. The vaccination clinics opened, administering over 500 vaccines per day across a 4-month period. The team involved continued to adapt processes and environment to suit the constantly changing guidelines and ensure safe practice.Simulation is an adaptive and responsive tool in systems testing, process mapping and implementing solutions within a high-pressured and time-restricted environment.
128 Efficacy of a Virtual Mock Trial for Inter-Professional Learning
Authors: Dickinson Karen , Ward Wendy L. , Minarcin Robert , Trudeau Christopher , Neill Kathryn 
Published: January 2022

A medical negligence trial can be stressful for all involved and may be the first time in a courtroom for many health professionals. To provide students with the opportunity to learn from, with and about each other, the Mock Trial was established as an annual collaborative learning event between a local law school and our university-affiliated Office for IPE (Inter-professional Education). In 2021, Mock Trial was conducted virtually to continue high-quality IPE throughout the COVID-19 pandemic.The aims of the study were to establish the efficacy of translation of a large-scale inter-professional malpractice Mock Trial simulation to the virtual platform and to determine whether this will be a useful modality once social distancing restrictions ease.The virtual simulation was structured using the brief-simulation-debrief model. Students participated as jury members via Zoom. A simulated courtroom held 11 participants of the trial (one judge, four law students [two defence, two prosecutions], five witnesses and one administrator) and was broadcast in real time to students. The learners first heard the case (opening statements, Plaintiff’s case, Defendant’s case, closing statements and jury instructions) before moving to IP jury break-out rooms with facilitator supervision to deliberate a verdict. Verdicts were delivered in the main room, followed by a debriefing. All students completed a pre-/post-questionnaire, including the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and evaluation of simulation methodology, Mock Trial structure/content and overall impression. To assess efficacy, we compared student evaluations from 2018 and 2019 (in-person events) to those from 2021 (virtual).A total of 179 learners participated in three in-person Mock Trials; 143 attended the virtual offering. The virtual event included learners from 19 professions from 4 institutions and 12 facilitators. Evaluations assessed IPEC competencies. For the virtual Mock Trial, learners (96%) strongly agreed/agreed that ‘this activity demonstrated the value of IP collaborative practice to prevent malpractice lawsuits’ and 97% felt that this was a valuable educational activity. Representative qualitative data include: ‘as a law student it was interesting to see what laypeople take away from evidence…’, ‘watching the process provided insight into the litigation process’, ‘the most valuable experience is hearing other people’s perspective’.Large-scale virtual simulation events such as a Mock Trial are feasible and provide a valuable inter-professional learning experience. Student feedback demonstrates that gaining insight from different perspectives is a meaningful part of the experience. Incorporation of large-scale simulation events post-pandemic can increase accessibility to foster IP learning on a wider scale.
174 Increased Self-Efficacy in General Practice and Higher Psychiatric Trainees Following Simulation-Based EDUCATION TO SUPPORT INTER-PROFESSIONAL CO-CONSULTING IN PRIMARY CARE
Authors: Tcholakova Kalina , O’Sullivan Owen P. , Iannelli Hannah , Attoe Chris 
Published: January 2022

Learning Together is a training model providing general practice (GP) and higher psychiatric trainees with peer learning opportunities across London in partnership with Health Education England. The initiative encompasses inter-speciality training days and joint clinics delivered by trainee pairs aiming to bridge the gap between mental healthcare in primary and secondary care. On the basis of this model, a full-day online simulation-based education (SBE) course for these groups was designed and delivered with a specific focus on inter-professional education and issues related to co-consulting The aim of this study was to use SBE to enable sharing of knowledge, skills and approaches to clinical practice to improve inter-professional collaboration in the context of co-consulting in primary care.A full-day online SBE course for GP (ST2/3) and higher psychiatric trainees (ST4 and above) was delivered to 64 participants over six deliveries. It included five live scenarios using professional actors depicting mental health presentations to reflect the overall learning objectives. Scenarios were followed by a structured psychologically informed debrief chaired by trained facilitators with support from an external senior GP. A mixed-methods evaluation was used. Participants completed the Human Factors Skills for Healthcare Instrument (HuFSHI) pre- and post-course, rating their level of self-efficacy in managing issues, such as ‘constructively managing others’ negative emotions at work’ and ‘working effectively with a new team in clinical situations’ (Cronbach’s alpha = 0.96) Responses from 51 participants were analysed (response rate = 79%). Median HuFSHI scores increased from 70 to 86 for the overall group (Z = 5.881, p < 0.001). Sub-group analysis between both trainee groups (i.e. GP and higher psychiatric trainees) showed no significant HuFSHI score differences. High scores were reported for scenario quality (90% of participants) and provision of a safe and constructive learning environment (91.7% of participants). Ninety per cent of respondents would recommend the course to colleagues. Emerging themes from the qualitative data were positive reflections on the importance of patient-centred care and appreciation of the value of inter-professional collaboration and joint clinics.Findings demonstrated improvements in participants’ self-efficacy as measured by HuFSHI. Qualitative data suggest a deeper understanding and appreciation of patient-centred care and inter-professional collaboration. Considering the need for early intervention, prevention and delivery of mental healthcare in primary care, this early evidence supports the potential role of SBE in developing integrated care.
NEKE KARAKTERISTIKE TRAHEJA OBIČNE BUKVE (Fagus silvática L.)
Authors: Gurda Safet 
Published: January 2022

Ovaj rad se bavi varijabilnošću traheja unutar debla i grana bukve
(Fagus silvática L.). Dužina, prečnik i zapreminski dio elemenata traheje u deblu
i u normalnom i tenzijskom drvetu grane su analizirane.
METODIKA PREMJERA I REGISTROVANJA PODATAKA U JEDNODOBNIM ŠUMSKIM ZASADIMA SMRČE (PICEA ABIES KARST.), BIJELOG BORA (PINES SYLVESTRIS L.) I CRNOG BORA (PINUS NIGRA ARN.) U BOSNI I HERCEGOVINI
Authors: Pavlič Janez 
Published: January 2022

Ovaj rad se bavi odabirom i uspostavljanjem privremenih oglednih ploha
u jednodobnim sastojinama smrče (Picea abies Karst.), bijelog bora (Pinus
sylvestris L.) i crnog bora (Pinus nigra Arn.) u Bosni i Hercegovini za
prikupljanje podataka potrebnih za gazdovanje šumama. Podaci koje treba prikupiti na
plohama su navedeni i detaljno je opisan način njihovog uzimanja-mjerenja.