Introduction: Simulation-based education is essential for developing procedural competence in ultrasound-guided thoracentesis (USGT). However, few USGT phantoms integrate objective metrics to assess cognitive workload. This study used eye tracking (ET) to quantify cognitive demand and establish preliminary validity evidence for a novel, anatomically variable USGT phantom. Materials and Methods: Thirteen experienced clinicians performed simulated USGT on a modular phantom divided into 4 quadrants of increasing difficulty. Eye-tracking glasses recorded gaze behaviour across 2 areas of interest: the ultrasound monitor and the phantom. Cognitive workload was assessed through fixation and revisitation counts. Postsimulation, participants completed a Likert-scale questionnaire and provided qualitative feedback. Results: The monitor elicited significantly more fixations than the phantom [[91.6 ± 12.4 vs. 38.8 ± 12.4; F(1,87.1) = 20.26, P < 0.001], particularly in the most complex quadrant (Q3). Revisitation counts trended higher on the monitor but were not statistically significant overall ( P = 0.08); however, Q3 showed significantly more revisitations than Q4 ( P = 0.01). Q3 also required the most puncture attempts (2.31 ± 0.40; P = 0.001), aligning with increased cognitive workload. Realism and educational usefulness received high ratings (24/30 and 14.1/15, respectively). Thematic analysis highlighted anatomic fidelity, graduated difficulty, and integration of image acquisition with needle guidance as key strengths. ET revealed quadrant-specific variations in cognitive workload, demonstrating the phantom's structural design potential for progressive, scaffolded training. Fixation and revisitation metrics provided response process validity evidence, linking gaze behaviour to task complexity. Expert feedback confirmed the phantom’s realism and educational value, reinforcing its feasibility as a platform for structured, just-in-time training. Conclusion: ET offers a powerful lens to evaluate cognitive demands in procedural simulation. This study demonstrates how gaze metrics can inform phantom design and assessment, enhancing the fidelity and effectiveness of USGT training.
Introduction: This study explores medical students’ perceived learning, emotional responses, and sense of preparedness following simulated death and near-death scenarios to understand how learners interpret these emotionally challenging simulation experiences. Simulation-based medical education empowers students to develop clinical skills in a safe environment, including dealing with critical scenarios involving a patient’s death. While these simulations may evoke intense emotional responses, they may also provide thought-provoking learning experiences that promote deeper reflection and introspection. Methods: We adopted an interpretative qualitative approach. Thirteen final-year medical students were recruited using a purposive sampling technique. They were exposed to simulation sessions involving death and near-death using a high-fidelity manikin. A semistructured interview was conducted, and the data were analyzed using thematic analysis. The trustworthiness of the data was ensured through credibility, transferability, dependability, and confirmability criteria. Results: Five main themes emerged from simulation experiences, i.e emotional responses to simulated death, learning through simulated death, impact on motivation, realism and immersion, and challenges during simulated death. Participants described emotions such as sadness, guilt, and acceptance of death as part of the learning process. Simulation-based learning provided a platform for self-reflection, empathy, safe practice, and preparation for real-life scenarios. Challenges such as limited knowledge and skills, difficulties in leadership and teamwork, and emotional management were identified as subthemes within the challenges theme. Conclusion: Simulated death may prompt emotional, motivational, and professional reflection among students, while also revealing the need for stronger educational support within simulation-based training. Incorporating structured debriefing and psychological support could help learners better navigate emotionally complex simulation experiences.
Introduction: Effective neonatal resuscitation at birth is crucial for survival and has the potential to reduce neurodevelopmental morbidities. While traditional simulation-based training in neonatal resuscitation shows greater skill attrition over time, the Rapid Cycle Deliberate Practice (RCDP) approach, a method involving repeated in-simulation practice with immediate feedback, may enhance skill acquisition and retention. However, evidence favoring RCDP in neonatal resuscitation is lacking, particularly in low-income and middle-income countries. Methods: In this randomized trial, pediatric residents (n=39) and nurses (n=9) with prior neonatal resuscitation training within 3 months to 2 years from the date of enrolment participated in simulation-based sessions using either RCDP or conventional simulation and debriefing (CSD). Simulation sessions were conducted utilizing a standardized approach developed by the simulation team. Three simulation scenarios with the same learning objectives were created by the simulation team; minor modifications were made during simulation conduct, assuring that different scenarios were used for training and assessment for the same group. Simulation sessions used for assessment were video recorded, and video raters were blinded to the group allocation. The primary outcome was skill and knowledge retention 1 month after training, assessed using the modified Neonatal Simulation Assessment Score (N-SAS) tool. The secondary outcome was skills and knowledge measured immediately. Performance between RCDP and CSD groups was compared utilizing using the Student t test. Both primary and secondary outcomes were tested in a simulation setting. While long-term retention is of interest, the feasibility of this study only allowed for a 1-month assessment. Results: The mean cumulative N-SAS score 1 month after training was significantly higher in the RCDP group compared with the CSD group [51.8 (4.3) vs. 47.1 (2.4), mean deviation (95% CI): −4.8 (−7.7, −1.8), P =0.003]. Out of the 6 domains in the N-SAS tool, the RCDP group performed better than the CSD group in the preparation domain [20.4 (2.4) versus 18.2 (2.4); mean deviation] (95% CI): −2.3 (−4.3, −0.2), P =0.03]. Regarding secondary outcomes, the RCDP group performed better than the CSD group immediately after training overall, with a statistically significant difference noted in the domains of chest compressions and epinephrine administration. Conclusions: The RCDP compared with the CSD simulation training resulted in improved performance in a simulated setting, as measured by the N-SAS tool, both immediately after the training and 1 month post-training.
Introduction: Simulation is widely used in obstetric training; however, there is limited understanding of how early-stage trainees integrate technical and nontechnical skills under realistic clinical pressures. This study explored how early-stage trainees integrated technical and nontechnical skills while managing concurrent clinical demands during a simulated obstetric on-call shift. Methods: A qualitative observational study was conducted in a simulated labor ward during a regional training day. Fourteen obstetrics and gynecology trainees (years 1 to 2) participated in a 40-minute simulated on-call shift involving concurrent management of patients across multiple clinical areas, followed by a facilitated focus group discussion. Some participants were deliberately assigned roles with responsibilities beyond their actual training grade. Data were analyzed thematically, with triangulation across participant observation, field notes, movement-tracking diagrams, simulation transcripts, and focus group data. Results: Trainees completed familiar technical tasks, although some preparatory steps required prompting. Observed hesitation, requests for guidance, and reliance on prompting occurred during complex decision-making, obtaining consent for instrumental birth, and escalation of care. These behaviors occurred while some trainees were undertaking assigned roles with responsibilities beyond their training grade. Coordinated teamwork behaviors were observed alongside communication lapses and disrupted role allocation. Participants described the simulation environment as psychologically safe and valued the opportunity for experiential learning and reflection. Conclusions: The simulated obstetric on-call shift was practicable to deliver within a regional training day and was acceptable to participants as a learning activity. It provided a structured approach for observing the integration of technical and nontechnical skills during concurrent clinical demands. The findings describe behavior within assigned simulated roles and should not be interpreted as an assessment of competence or readiness at the participants’ actual training level.
Summary Statement: Competency-based education (CBE) has become a prevalent framework in health professions education, emphasizing observable outcomes, learner progression, and accountability to patient needs. This scoping umbrella review examined how simulation-based education (SBE) is being used to support and implement CBE across health care professions and disciplines. Across 44 reviews, SBE was used to support knowledge, skills, clinical reasoning, communication, teamwork, and confidence. High-fidelity simulation, virtual reality, standardized patients, and hybrid modalities were commonly used to support deliberate practice and competency-focused learning. Despite this alignment, SBE was frequently implemented as a discrete educational modality rather than as a longitudinally integrated component of competency-based curricula, with inconsistent reporting of competency frameworks, theory-informed design, debriefing approaches, and programmatic assessment strategies. This review synthesizes key findings, gaps, and recommendations and proposes a simulation-grounded CBE framework to guide the intentional integration of SBE within competency-based health care curricula.
