The Team Emergency Assessment Measure (TEAM) is the most widely used tool for evaluating emergency team performance, with robust psychometric evidence across multiple languages and settings. However, no European Spanish version has been validated, and no previous TEAM study has simultaneously assessed teamwork from four complementary rater perspectives: instructors from the learners’ own specialty, instructors from other specialties, self-assessment by the performing participants, and peer-assessment by observing peers. This study aimed to translate, culturally adapt, and psychometrically validate a European Spanish version of the TEAM (s-TEAM) and to evaluate its reliability and validity across these four perspectives in emergency simulation scenarios, with peer-assessment representing a novel contribution of this work. The TEAM was translated and adapted into European Spanish following internationally recommended guidelines. The s-TEAM was applied across 216 high-fidelity cardiology emergency simulation scenarios within nine editions of a national training programme for second-year cardiology residents organised by the Spanish Society of Cardiology. Ratings were collected simultaneously from all four perspectives. Internal consistency, item analysis, concurrent validity, and factor structure (EFA and CFA on independent subsamples using polychoric correlations) were examined. A total of 145 residents were registered across the nine course editions, with 30 participating instructors and 216 scenarios. The final analytical sample comprised 1,414 valid ratings. Internal consistency was excellent overall (Cronbach’s α = 0.921) and across all rater groups (range 0.901–0.938). The total score correlated strongly with the Global Rating Scale (r = .816). Factor analysis supported a predominantly unidimensional structure with a distinguishable Leadership/Communication facet (interfactor correlation 0.904–0.908). Peer-assessment yielded reliable scores (α = 0.901) comparable to other rater groups. Instructors from the residents’ own specialty (cardiologists) scored significantly lower than all other groups (d = − 0.42). Internal consistency was stable from the first scenario (α = 0.900) despite the absence of formal rater training. The s-TEAM is a valid, reliable, and feasible European Spanish adaptation of the TEAM. It produces consistent scores across four rater perspectives, enabling multi-source feedback during debriefing without additional faculty. These findings support its integration as both an assessment and formative tool within iterative simulation curricula.
Neonatal abduction within a hospital is an extremely rare but potentially catastrophic event. Accreditation frameworks such as Joint Commission International (JCI) require hospitals to demonstrate that procedures for such events are not only documented but operationally sustainable. Translational simulation offers a structured method to evaluate the gap between written procedures and real operational capability. This study describes a tabletop translational simulation designed to stress-test the neonatal abduction procedure at Meyer Children’s Hospital IRCCS (Florence, Italy). A descriptive observational study based on a system-oriented tabletop simulation was conducted on 11 November 2025, following the Input–Process–Output framework and the INACSL Healthcare Simulation Standards of Best Practice. Five plausible escape routes were identified and physically walked beforehand to obtain objective escape times, then used as fixed scenario inputs initiated at T0. Participants from neonatal and paediatric intensive care, the hospital non-clinical emergency service, and the hospital internal police were informed of the simulated event two minutes after T0. Data included chronological organisational actions, procedure accessibility, staff allocation, and qualitative feedback from structured responses and debriefing. The five escape routes were completed between three and just over six minutes after T0, representing the structural constraints of the environment. The first call to the hospital internal police occurred more than five minutes after notification, and the hospital non-clinical emergency service reached the main exits seven minutes after notification — after all escape routes had already been completed. Contacting the hospital non-clinical emergency service was a spontaneous action not prescribed by the procedure. Intranet retrieval of the procedure required over four minutes in the neonatal unit. Tabletop translational simulation proved feasible and informative for evaluating the operational sustainability of a neonatal abduction procedure. The findings reveal a structural temporal gap between escape completion and effective organisational response — a vulnerability that written procedure review alone would be unlikely to detect — and were translated into organisational recommendations to support procedural revision, although the reported timings represent point estimates derived from a single observation rather than distributions and should be interpreted accordingly.
Debriefing is central to healthcare simulation, yet quality assessment relies on expert raters and substantial faculty time. Large language models (LLMs) may support transcript-based quality review using validated instruments such as the Debriefing Assessment for Simulation in Healthcare (DASH). Still, evidence is needed on agreement patterns and the constraints of transcript-only assessment. This study compared concordance between human experts and personalized ChatGPT models for DASH scoring of debriefing transcripts. A prospective, multicentric pilot study with a mixed-methods design analyzed 33 high-fidelity simulation debriefings. Transcripts were evaluated by human experts (n = 150 evaluations) and personalized GPT-4.0 and GPT-4.5 models (n = 345 evaluations total) using DASH items 2–6 (score range 5–35). An adaptive design selected the best-performing AI model based on internal consistency (Cronbach’s α ≥ 0.7) and inter-evaluator concordance (ICC ≥ 0.5). Quantitative analyses included continuous and categorical concordance measures, and qualitative analysis used comparative content analysis. GPT-4.5 demonstrated superior performance (α = 0.870) compared with GPT-4.0 (α = 0.427) and was selected for the main analysis. Continuous analyses showed moderate concordance with human experts (ICC range 0.290–0.560; median 0.455). Categorical analyses showed high agreement (95–100
Translational simulation is now established as a conceptual framing for aligning simulation with healthcare quality and safety priorities, but the development of organisational capacity for this work remains poorly described. We explored how translational simulation programs build capacity, with a specific focus on the role of formal faculty development. We used a constructivist qualitative approach informed by collaborative autoethnographic principles to explore how translational simulation programs build capacity through program-level decisions and faculty development strategies. Data were generated through a recursive, multi-stage narrative process, including structured written accounts from leaders of three Australian simulation programs and a narrative from the coordinator of the group-based Applied Translational Simulation course. Narratives were iteratively revised in response to written prompts to deepen description and interpretation. Data were analysed using reflexive thematic analysis, with concepts and themes developed through paired review, whole-team discussion, and re-examination of the complete dataset. Five themes were identified: strategy and leadership drive capacity building; program context shapes approach; translational simulation capacity is integrated, not isolated; trigger events create motivation and opportunity; and building capacity is relational. Capacity is developed through doing translational simulation work, supported by mentorship, projects, advocacy, and shared language, with formal faculty development providing structure and legitimacy. Faculty development contributes most when embedded within broader institutional conditions that support translational simulation practice.
Developing both technical and non-technical competencies is a core goal in physiotherapy education. While traditional clinical placements offer essential hands-on experience, they may not fully prepare students for the complexity and unpredictability of real-world clinical practice. Simulation-based education (SBE) can help bridge this gap by providing a safe, realistic, and structured learning environment. To explore undergraduate physiotherapy (PT) students’ experiences of curriculum-integrated high-complexity SBE, through the lens of experiential learning theory. Qualitative descriptive study. Faculty of Health Sciences and Wellbeing, University of Vic – Central University of Catalonia, Spain. Twenty-eight undergraduate PT students from the second, third, and fourth academic years (fourth, sixth, and eighth semesters, respectively) participated in six focus groups conducted between June and October 2024. Participants were purposively sampled to ensure diversity in academic year and simulation roles (PT or observer). High-complexity simulation sessions embedded in the PT curriculum, involving trained simulated patients and structured facilitation. Students’ experiences of learning processes during SBE. Data were analysed using reflexive thematic analysis and later interpreted in relation to experiential learning theory. ATLAS.ti software was used to support data management. Transcripts were returned to participants for member checking. Two overarching themes emerged: (1) Constructing non-technical skills through action, observation, and reflection, and (2) Experiencing safety and immersion. Students valued both performing and observing roles, reporting that observation fostered reflection, vicarious learning, and reduced performance anxiety. Structured debriefings, progressive exposure, and peer feedback reinforced learning, while facilitators’ guidance and psychological safety promoted confidence. The use of simulated patients enhanced emotional immersion and authenticity, and students highlighted their potential role in feedback. High-complexity SBE was perceived as a meaningful and situated learning experience that supported reflection, knowledge integration, and application, contributing to the development of non-technical skills and confidence. NCT06852482 (clinicaltrials.gov).
Communication in anesthesiology often occurs during brief, vulnerable, and technically complex perioperative encounters, yet simulation in this specialty has traditionally focused more on crisis management than on clinician-patient-family communication. We developed an AIDET-informed simulation curriculum for third-year anesthesiology residents to make these conversations observable, rehearsable, and debriefable. AIDET refers to acknowledge, introduce, duration, explanation, and thank; in this curriculum it was used as an organizing communication frame rather than as a script. The curriculum was developed by anesthesiology faculty, communication specialists, simulation educators, and role-player trainers, and combined four perioperative scenarios, trained simulated participants, structured observation, and facilitated debriefing. In a preliminary single-center historical-control evaluation, the 2021 cohort received standard communication teaching in January-February 2024 and completed OSCE assessment in June 2024, whereas the 2022 cohort received the AIDET-informed simulation curriculum in January-February 2025 and completed OSCE assessment in June 2025. Sixty residents were included, with 30 in each cohort. Local evaluation data showed higher simulated communication performance scores and more favorable simulated-participant ratings in the intervention cohort, together with lower self-reported stress and higher confidence in difficult conversations. We interpret these findings cautiously because allocation was by cohort rather than randomization, the evaluation was conducted in one center, and outcomes were assessed in simulated rather than workplace settings. This article presents the curriculum as a practice-oriented simulation strategy with preliminary local evaluation, not as definitive effectiveness evidence. We describe the design logic, learner flow, role-player preparation, evaluation methods, implementation lessons, and boundary conditions to support adaptation by other simulation educators.
Simulation-enhanced interprofessional education (Sim-IPE) has been successfully used in various health professions and shown to improve communication and teamwork. Surgery, where preventable serious adverse outcomes are often attributed to issues with communication and teamwork, represents a compelling context for Sim-IPE. However, implementing Sim-IPE in surgery requires investment in faculty development, equipment and facilities while incurring the cost of reduced staff availability and theatre productivity during simulation activity. We conducted a scoping review to characterise how Sim-IPE in surgery is practised and researched. This scoping review followed the methodological framework described by Arksey and O’Malley. Reporting followed the PRISMA-ScR checklist. Electronic databases (Medline, EMBASE, Web of Science, PsycINFO and ERIC) were searched for records pertaining to Sim-IPE in surgery published after 1st January 2000 and in English. The final analysis included 81 articles. Simulation scenarios showed a rich variety of combinations of professions, disciplines, training levels and settings. While most scenarios used manikins (N = 54, 75
Interprofessional collaboration is crucial for enhancing healthcare delivery, particularly in primary care settings, where effective teamwork between healthcare and social professionals (HCSPs) is essential. Despite its importance, there is limited research on the impact of structured interprofessional training programs on interprofessionality in simulated environments, particularly concerning primary care contexts. The REALISE study constitutes of a prospective feasibility study examining the impact on interprofessionality of multimodal, interprofessional learning paths on HCSPs as well as students within a simulated primary healthcare (PHC) setting. The three-week learning paths were specially developed, proprietary, case-oriented, and consisted of simulations (acting patients, high-fidelity manikins, virtual reality) and didactic on- and offline elements. The study employed a mixed-methods approach, incorporating three conducted interprofessional intervention groups to evaluate outcomes across both quantitative (two standardized assessments: Interprofessional Collaborative Competency Attainment Survey (ICCAS), Interprofessional Socialization and Valuing Scale 9a b (ISVS)) and qualitative (proprietary open-ended questions) domains. Data was collected before (t0), directly after (t1) and two months after t1 (t2) to evaluate the impact on interprofessional collaboration. Regarding the quantitative outcomes, no significant change was observed in participants’ ISVS scores between pre- and post-intervention assessments, neither in the entire sample (t0 = 5.41 ± 1.20, t1 = 5.85 ± 1.18; p = 0.108), nor in the student or HCSP group. Also, no time*group effects became evident. This suggests stable self-perceived values and attitudes toward interprofessional collaboration. In contrast, ICCAS scores increased significantly in total and across all dimensions (e.g., total score t₀ = 3.00 ± 0.77, t₁ = 3.99 ± 0.53; p < 0.001, d = 0.91). The strongest effects for the entire sample were observed in the dimensions “Team Functioning” (0.973) and “Collaboration” (0.922) and significant time*group (students vs. HCSPs) effects were found in 3 of the 6 dimensions (“Collaboration”, “Roles and Responsibilities” and “Team Functioning”), indicating substantial self-reported improvements in interprofessional competencies following the training and differences in amplitude of improvements. The results of the qualitative thematic analysis showed clear differences and overlaps between groups and time points. At t0, the students described communication difficulties, unclear responsibilities and role confusion as central challenges. In contrast, HCSPs focused on structural problems such as time pressure and limited coordination. At t1, the students reported increased role clarity and improved team communication, while HCSPs noted greater awareness of their own role and greater flexibility in interdisciplinary cooperation. As part of the follow-up (t2) the HCSPs reported a further deepening of interprofessional cooperation in their daily practice. While participants’ self-perceived attitudes remained stable, significant improvements in interprofessional competencies such as team functioning and collaboration, showed that the training effectively supported collaborative practice. The intervention was feasible to implement and was positively evaluated across all professional groups. What are the main findings? What are the implications for (continued) education?
Simulation facilitation models have developed predominantly in Western educational settings. The ways in which cultural norms, particularly kreng-jai and deference to authority, shape nursing student participation in high power-distance contexts have received limited empirical attention. This study examined how stress, role positioning, and facilitator feedback timing and tone interact to shape participation and culturally safe learning in simulation-based nursing education in Thailand. Semi-structured interviews were conducted in Thai with 24 third- and fourth-year nursing students in Eastern Thailand between August and October 2024. Interviews lasted 45–60 min and were analysed using reflexive thematic analysis. Four themes were developed. Entering a New Space positioned simulation as a threshold where visibility intersected with kreng-jai-patterned restraint; students’ reluctance to speak was culturally rational rather than disengagement. Stress as a Double-Edged Sword in Simulation showed that pressure could sharpen recall and prioritisation but could also narrow participation when abrupt feedback arrived mid-scenario. Learning Across Participation, Observation, and Debriefing identified distinct but complementary learning routes: active scenario participants acted under time pressure, whereas observers developed an analytic perspective, with both perspectives converging during debriefing. Facilitation and Cultural Safety found that calm guidance kept kreng-jai compatible with engagement, whereas abrupt correction rendered silence a response to relational risk. Participation and psychological safety in simulation were not inherent features of instructional design but were interactionally and culturally mediated through facilitation, role positioning, and hierarchical norms.
Healthcare simulation training faces significant barriers due to the “clinician-developer gap,” where educators lack programming expertise to create customized digital simulators. Natural Language-Driven Development (NLDD) is an emerging paradigm that enables clinicians to develop educational technology through conversational artificial intelligence interfaces. We implemented NLDD methodology to develop Open Vent Sim, a comprehensive mechanical ventilation simulator designed to replace anesthesia machines and ventilators in educational contexts lacking dedicated equipment. A multidisciplinary team comprising anesthesiologists, residents, a research nurse, IT, and biomedical engineers collaborated using Google AI Studio to iteratively create a web-based application through natural language prompts. Development proceeded through conversational cycles in which clinical requirements were translated into functional code via large language model assistance. Open Vent Sim was successfully developed in about 40 h over two weeks, featuring three simulation environments: anesthesia workstation, ICU ventilator, and high-flow oxygenation systems. The simulator incorporates physiological patient profiles (normal, ARDS, COPD) with dynamic compliance calculations and realistic waveform generation. Clinical validation was achieved through the integration of continuous resident feedback during iterative development. The application was successfully implemented in SimZone 1 as an interactive skill trainer and in SimZone 2 for team-based clinical scenarios during formal anesthesia and critical care education. Significant technical adaptation was required to transform the AI-generated prototype into a production-ready application. NLDD demonstrates the potential to democratize the creation of educational technology by empowering clinical domain experts to develop sophisticated simulation tools without traditional programming expertise. This approach addresses resource limitations while maintaining clinical authenticity, though professional technical oversight remains essential for production-ready implementations.
Simulation-based education is widely recognised as a key strategy in health professions training, yet the quality and sustainability of simulation initiatives depend heavily on the preparation of faculty responsible for facilitation, scenario design, and debriefing. While international standards provide guidance for simulation practice, implementing faculty development programs can be challenging in institutions characterised by limited resources, high teaching workloads, and heterogeneous faculty experience. Detailed accounts of how such programs are designed, implemented, and sustained within real institutional constraints remain limited. This paper describes the design, implementation, and reflective analysis of a hybrid faculty development architecture for simulation facilitators developed within a Brazilian higher education institution. The program was informed by experiential learning theory, adult learning principles, and implementation science perspectives, and was developed following an institutional needs assessment. The architecture combined asynchronous preparatory learning, synchronous online discussions, and experiential in-person workshops focused on scenario design and debriefing practice. A six-month responsive longitudinal support component was incorporated to facilitate transfer of learning into authentic teaching contexts. Communication and reinforcement mechanisms were integrated into institutional digital platforms already used by faculty in order to minimise participation barriers. Implementation indicators demonstrated feasibility and high participant acceptability within the institutional context. Implementation revealed both strengths and tensions. The structured experiential phase proved operationally stable and aligned with faculty learning needs. However, utilisation of the optional mentorship component remained limited, highlighting the challenges of sustaining engagement in contexts characterised by competing professional demands. Descriptive readiness profiles suggested developmental progression among participants, although the architecture was not designed as a formal competency assessment framework. Reflective analysis of the implementation process allowed the identification of design principles related to feasibility, contextual adaptation, reinforcement strategies, and institutional integration. This practice-based account illustrates how simulation faculty development initiatives can balance pedagogical rigour with contextual feasibility. Rather than proposing a new competency framework, the architecture offers an implementation-oriented approach for supporting faculty development in resource-constrained educational environments. The experience suggests that foundational experiential training, flexible reinforcement strategies, and integration within existing institutional ecosystems may offer transferable insights for institutions seeking to expand simulation capacity under similar structural constraints. The study was registered in the Brazilian Registry of Clinical Trials (ReBEC), number RBR-4dqtygd.
The simulation community has invested heavily in educational rigour (validated debriefing methods, high-fidelity technology, faculty development), yet evidence linking simulation to sustained clinical improvement remains limited. We propose this gap exists not because simulation is ineffective, but because it is poorly positioned within organisational systems. Drawing on a decade of programmatic experience at a non-academic hospital, including multiple initiatives that did not produce sustained outcomes and subsequent methodological pivots, we argue that simulation achieves sustainable impact only when embedded within quality improvement infrastructure. Using the Donabedian model as a conceptual framework, we demonstrate that process-focused interventions (education, training) without corresponding structural supports (equipment, systems, protocols) produce transient change at best. Integrated approaches, where simulation serves as a quality improvement tool to identify system threats and monitor interventions through Plan-Do-Study-Act cycles and the SAFER-Matrix, produce measurable, sustained improvements. Evidence from in situ programmes across emergency departments and cardiac catheterisation laboratories, multi-site collaboratives, and AI-powered telehealth simulation demonstrates that this integrated approach succeeds where education alone falls short. We have formalised these principles in the Simulation-Quality Integration (SIM-QI) Framework, currently submitted for independent peer review, which provides a practical blueprint for embedding simulation within QI infrastructure. We present actionable implications for simulation educators, institutions, and researchers seeking to bridge the gap between educational excellence and clinical translation.
NHS Scotland Academy functions as a national mechanism for translating Scottish Government workforce and quality priorities into deployable, simulation-enabled interventions. This article is presented in three parts. The first section describes how NHS Scotland Academy operationalises simulation within a commissioning-to-closure infrastructure comprising staged initiation and approvals, collaborative co-design, structured delivery supported by embedded faculty development, iterative evaluation, proportionate change control, annual review, and formal close/transfer processes. Part 2 presents two exemplar programmes which illustrate how this lifecycle connects simulation to healthcare quality and safety through a translational simulation lens: the Accelerated Anaesthetic Practitioner Programme, commissioned to address prolonged anaesthetic practitioner training and perioperative service pressures; and the National Endoscopy Training Programme, designed as a simulation-powered workforce and quality driver within endoscopy recovery. Building on the broader evolution of IPO (inputs-processes-outputs) in team science, Part 3 suggests the ways in which the learning from NHS Scotland Academy may contribute to the development of translational simulation theory, particularly through recognition of mediating mechanisms, episodic temporality, and cross-level causation. NHS Scotland Academy’s infrastructure and exemplars make these features more visible and suggest how the theory might be refined while retaining the pragmatic utility of IPO. Overall, this Advancing Simulation Practice article positions NHS Scotland Academy both as an effective national delivery platform for simulation-enabled workforce and quality programmes and as a testbed for advancing translational simulation conceptual models.
BACKGROUND:This study aimed to determine whether a distance-based CPR training program with asynchronous feedback for laypersons is non-inferior to the traditional in-person Heartsaver® First Aid CPR AED course. METHODS:After approval by the ethics committee, 192 non-medical personnel were recruited to participate in this study. Participants were randomly assigned to two different training methods: Traditional in-person Heartsaver® First Aid CPR AED course (T-course).Distance-based course offering asynchronous feedback through an online platform (D-course). For the distance-based course, materials for practice were available at the participants' workplace (pad, resuscitation torso, an automated external defibrillator). The video-based assessment and feedback platform C1DO1 was used (https://c1do1.ai/). The course was structured in 9 stages on the platform, with theoretical and practical steps. Participants reviewed the videos and practiced unsupervised, uploading video recordings of their practice, and instructors assessed and provided feedback asynchronously on these videos. Participants then reviewed their own videos with the feedback and practiced again until approval. Both groups completed a pre-training (PRE) and post-training assessment (POST). During both assessments, participants were recorded performing CPR. Videos were evaluated by two independent, blinded reviewers who rated participants' performance using the AHA Heartsaver Adult CPR and AED skills testing checklist. Additionally, the quality of chest compressions (CC) was measured with the Prestan simulator application. RESULTS:Of the 192 participants recruited, 172 completed the training, and 158 took the PRE and POST assessments. (83 finished the T-course and 75 the D-course). Median Heartsaver Adult CPR and AED skills testing checklist scores increased from 2 (0-3) to 15 (14-16.5) points in the T-course and from 1 (0-2.5) to 16 (15.5-17) points in the D-course. The difference in POST assessment median scores between groups was -1 (95% CI: [-1.5, -0.5]), with the lower bound above the pre-established non-inferiority margin, confirming the non-inferiority of the D-course. The median CC rate increased from 82 (0-106)/min to 105 (102-110)/min in the T-course and from 86 (0-109.5)/min to 105 (105-108)/min in the D-course. The median CC depth rose from 38 (0-57.5) mm to 58 (49.5-60) mm in the T-course and from 32 (0-56) mm to 59 (55-60) mm in the D-course. CONCLUSIONS:Both training programs significantly improve participants' proficiency in CPR. The distance-based course with asynchronous platform feedback was non-inferior to the traditional Heartsaver® First Aid CPR AED course.
High-fidelity simulation (HFS) provides a controlled environment for training, allowing ambulance clinicians’(ACs) to practice and refine their skills without risking patient safety. Additionally, it enables the replication of complex scenarios, ensuring comprehensive preparedness for real-life emergencies. However, there remains a need to understand how frontline professionals in ambulance services experience these simulation-based activities. This is especially true when using high-fidelity modalities that aim to replicate real-world scenarios for research purposes. To explore clinically active ACs´ experiences of participating in HFS. A qualitative design involving dyadic interviews with 16 ACs participating in a simulation scenario was conducted. The data were analyzed using the inductive content analysis method outlined by Elo and Kyngäs. Participants emphasized the importance of adopting the right mindset from the start of the scenario, as mental readiness was crucial for immersion. Although the scenario felt realistic, achieving full psychological fidelity remained challenging, as participants’ awareness of the simulation setup influenced their behavior during the scenario. The study underscores the importance of carefully designed HFS scenarios that prioritize psychological and environmental fidelity to support authentic engagement among clinically active ACs. This is particularly important in pre-hospital care, where direct access to real clinical situations is often restricted by ethical, practical, and organizational constraints. The findings indicate that well constructed simulations with coherent workflow sequences, professional actor–based patient representation, and realistic settings can function as a methodological bridge for capturing complex cognitive and emotional processes that are otherwise difficult to study in real world practice. Further refinement of simulation design, focusing on psychological presence rather than complete physical or technical realism, may strengthen simulation-based research as a method for investigating experiential aspects of pre-hospital care.
Post-resuscitation debriefing (PRD) enhances individual and team performance in emergency care, thereby improving patient outcomes and provider well-being. Despite support from the European Resuscitation Council and the American Heart Association, the optimal PRD framework remains undefined. This study compares how team members experience PRD when conducted using either the DISCERN or Post-Code Pause (PCP) debriefing framework in pre-hospital cardiac arrest simulations. In a randomized cross-over study, 40 medical doctors participated in four advanced life support (ALS) simulation scenarios. Participants acted exclusively within their usual roles as team leaders, while the remaining team members performed standardized roles in accordance with the scenario scripts. Each participant experienced two DISCERN and two PCP debriefings, with the order randomized. The primary outcome was the total score on the Debriefing Experience Scale (DES), with item scores as secondary outcomes. Linear models with generalized estimating equations (GEE) were used to account for repeated measures when comparing the mean scores between the debriefing frameworks. A total of 158 DES questionnaires were analyzed. Mean total DES scores were 4.15 (4.02; 4.28) for PCP and 4.16 (4.02; 4.29) for DISCERN (p = 0.93 for the comparison). These scores indicate a favorable debriefing experience for both frameworks. At the DES item level, no statistically significant differences were observed between frameworks, except for perceived physical comfort in the debriefing environment, which was rated significantly higher for DISCERN (DISCERN = 4.44 (4.27; 4.62), PCP = 4.13 (3.96; 4.30), p = < 0.0001). DISCERN and PCP provide similarly favorable debriefing experiences following simulated cardiac arrest scenarios, with no significant difference in overall DES scores. These findings suggest that both frameworks can be implemented without compromising perceived debriefing quality. Further research should include more professionally diverse participant samples and assess long-term debriefing outcomes. Clinical Trial Center UZ Leuven, S65846 September 2021.
Throughout Europe, Emergency Medical Services (EMS) rely heavily on Medical First Responders (MFR) to ensure early stabilization and appropriate handling of complex Mass Casualty Incidents (MCI). Mixed Reality (MR), also known as Augmented Reality (AR), provides interactive training by integrating real environments with digital components. This technology enables MFR to practise complex decision-making and hands-on interventions in high-stress, simulated scenarios. However, assessing its genuine effectiveness remains challenging, as true competency is often difficult to demonstrate outside real-life emergencies. This study aims to measure pre- and post-test changes in perceived self-efficacy among MFR following a targeted MR intervention focused specifically on the initial management of MCI. A pre-test/post-test survey design was employed with 274 MFR who underwent detailed MR training simulating complex, early-stage MCI scenarios. To analyze the intervention’s precise impact on participant confidence, data were analyzed using both within- and between-subjects ANOVA, providing information about the change in self-efficacy across the cohort. The analysis revealed a statistically significant increase in perceived self-efficacy among the 274 participants following the training (F(1,270)=169.36, p<.01, η2=.385). The mean score increased from 34.45 (SD=6.27) to 38.38 (SD=5.40), representing an absolute increase of 3.93 points. This corresponds to an 11.41
Artificial intelligence is increasingly being integrated into healthcare education and simulation-based education. However, its role in supporting the debriefing phase of simulation remains underexplored and inconsistently described. This scoping review aimed to map the existing literature on the use of artificial intelligence to support debriefing in simulation-based healthcare education. A scoping review was conducted in accordance with Arksey and O’Malley’s framework and Joanna Briggs Institute guidance and reported in line with PRISMA-ScR. MEDLINE, Scopus, Web of Science, and CINAHL were searched without date restrictions. Eligible studies examined the use of artificial intelligence to support debriefing-related processes within healthcare simulation. Data were charted using a structured extraction form and synthesised descriptively and thematically. Seven studies published between 2023 and 2026 met the inclusion criteria. Studies were conducted in the United States, Switzerland, Chile, and South Korea. Artificial intelligence applications clustered into three domains: communication and performance analytics using speech recognition and natural language processing; generative artificial intelligence systems supporting facilitator feedback and structured report generation; and learner-facing reflective dialogue systems. Across the included studies, artificial intelligence was mainly positioned as an adjunct to human facilitation rather than as a replacement for facilitators. Reported outcomes focused primarily on feasibility, usability, technical accuracy, and perceived educational value, with limited evidence of objective improvements in learner performance or clinical outcomes. Artificial intelligence is emerging as a supportive tool for debriefing in simulation-based healthcare education. Current evidence remains limited, exploratory, and largely single-institutional, indicating the need for more rigorous research on educational effectiveness, ethical implementation, and the continuing role of human facilitation.
Abstract Background Surgeons need to master many manual skills, which potentially decrease with age. Yet, there is no standardized approach to objectively assess how aging affects basic surgical performance and skills training. In this context, simulation offers a promising solution, being widely used to train and test novice clinicians. This study aims to evaluate the impact of age on performance using a visuo-haptic surgical simulator. Methods A total of 39 participants were divided in two groups: 20 young (20–40 years) and 19 older adults (50–70 years). All participants completed multiple repetitions of three basic surgical tasks using a custom visuo-haptic simulator: incision, an adapted version of the needle threading task, and suturing. Performance metrics such as errors, trajectory, and task duration were compared between groups and across repetitions. Results Younger participants outperformed older ones in all tasks. Specifically, they cut more tissue, made fewer errors in the dexterity task, and sutured faster. Both groups partially improved with practice, although older subjects improved less than younger ones. Conclusions Altogether these results suggest that age significantly affects performance in basic surgical tasks; moreover, older subjects might benefit from periodic training sessions to maintain their skills. In this regard, visuo-haptic simulation can serve as an effective training and evaluation tool to assess and counteract the effects of aging on surgical ability.
