Introduction The 2020 American Heart Association\'s (AHA) Basic Life Support (BLS) curriculum focuses on cardiac arrest resuscitation with one or two rescuers, providing only limited opportunities to develop higher-level skills such as leadership, communication, and debriefing. This mixed-methods pilot study evaluated whether supplementing the traditional Heartcode BLS course with a high-fidelity teamwork simulation session improved mastery of these higher-level skills. Methods Twenty-four first-year medical students completed the pilot training during sessions offered in February and May of 2023. The program included the traditional AHA Heartcode BLS course, which ranges from two to four hours, and includes both online and in-person skills components. This was followed by a 90-minute high-fidelity simulation session consisting of two simulated resuscitations separated by a student-led plus/delta debriefing. Facilitators then debriefed the entire activity. Students completed an anonymous online survey that used a 0-10 slider scale to attribute their perceived proficiency for specific skills to the initial BLS course or the teamwork simulations and provided qualitative feedback. Results Twenty-one students (87.5%) completed the follow-up survey. Students credited their proficiency in technical skills (e.g., \"Chest Compressions\") to both sessions equally, but proficiency in higher-level skills, such as leadership, communication, and teamwork, was predominantly credited to the simulation. Additionally, students reported that the teamwork simulation promoted realism and increased self-efficacy. Conclusion Team-based resuscitation simulations using high-fidelity equipment augmented the AHA BLS course by promoting perceived competence in team dynamics domains and increasing students\' self-efficacy for participating in real hospital-based resuscitations. Studies with larger sample sizes and objective data should be performed, and the use of similar resuscitation simulations or the development of a formal team-based BLS certification course should be considered.

For nurses, clinical competency is paramount in ensuring that patients receive safe, high-quality care. Multi-patient simulation (MPS) in nursing education is gaining attention, and evidence shows its suitability for real-life situations. MPS can be an effective solution for nurses\' continuing clinical education.
This project compares the effectiveness of MPS (involving both a standardized patient and a high fidelity simulator) and a single high-fidelity simulation (single HFS; only involving a high fidelity simulator) for enhancing the clinical competency of nursing students.
A stratified, permuted, block randomized controlled study design was used.
Sixty undergraduate nursing students in years 3, 4, and 5 were selected to participate. Subgroups with each comprising three undergraduate nursing students from different years were formed.
The participants were randomized to receive either an MPS (intervention group) or single HFS (control group) for 1 day; they later received the same intervention after a 30-day washout period. One objectively measured questionnaire and two self-reported questionnaires were used to measure clinical competency: the Creighton Competency Evaluation Instrument (CCEI), Clinical Competence Questionnaire (CCQ), and Simulation Effectiveness Tool - Modified Questionnaire (SET-M).
The results revealed significant between-group differences. Specifically, the intervention group showed greater improvement than the control group in both the CCQ (linear contrast [d] = 71.4; 95 % confidence interval [CI] = 53.407, 89.393; P < 0.001) and CCEI total scores (d = 7.17; 95 % CI = 5.837, 8.503; P < 0.001). The SET-M results indicated that 85 % of the participants (n = 51) strongly agreed that they felt more confident about performing a patient handover to the healthcare team after the simulation.
The study findings indicated that both the MPS and single HFS effectively enhanced students\' clinical competency. However, MPSs have superior educational outcomes relative to traditional single HFSs.

BACKGROUND: Education in nursing has noticed a positive effect of simulation-based education. There are many studies available on the effects of simulation-based education, but most of those involve a single institution, nonrandomized controlled trials, small sample sizes and subjective evaluations of the effects. The purpose of this multicenter randomized controlled trial was to evaluate the effects of high-fidelity simulation, computer-based simulation, high-fidelity simulation combined with computer-based simulation, and case study on undergraduate nursing students.
METHODS: A total of 270 nursing students were recruited from five universities in China. Participants were randomly divided into four groups at each institution: the high-fidelity simulation group, the computer-based simulation group, the high-fidelity simulation combined with computer-based simulation group, and the case study group. Finally, 239 participants completed the intervention and evaluation, with 58, 67, 57, and 57 participants in each group. The data were collected at three stages: before the intervention, immediately after the intervention, and three months after the intervention.
RESULTS: The demographic data and baseline evaluation indices did not significantly differ among the four groups. A statistically significant difference was not observed between the four methods for improving knowledge, interprofessional collaboration, critical thinking, caring, or interest in learning. While skill improvement differed significantly among the different groups after the intervention (p = 0.020), after three months, no difference was observed (p = 0.139). The improvement in skill in the computer-based simulation group was significantly lower at the end of the intervention than that in the high-fidelity simulation group (p = 0.048) or the high-fidelity simulation combined with computer-based simulation group (p = 0.020).
CONCLUSIONS: Nursing students benefit equally from four methods in cultivating their knowledge, interprofessional collaboration, critical thinking, caring, and interest in learning both immediately and over time. High-fidelity simulation and high-fidelity simulation combined with computer-based simulation improve skill more effectively than computer-based simulation in the short term. Nursing educators can select the most suitable teaching method to achieve the intended learning outcomes depending on the specific circumstances.
BACKGROUND: This clinical trial was registered at the Chinese Clinical Trial Registry (clinical trial number: ChiCTR2400084880, date of the registration: 27/05/2024).

OBJECTIVE: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students.
METHODS: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge\'s g.
RESULTS: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).
CONCLUSIONS: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

OBJECTIVE: This study aimed to evaluate the combination of virtual simulation and in-person simulation among undergraduate nursing students.
BACKGROUND: At present, in-person simulation is the main form of simulation in China. With the development of computer technology, computer-based virtual simulation is gradually applied in simulation and has shown unique advantages. However, simulation format that combines virtual simulation with in-person simulation is rare in China.
METHODS: This was a mixed methods study, which applied a QUAN→qual sequential explanatory approach.
METHODS: In the quantitative phase, a non-randomized controlled trial (NRCT) was employed among 93 junior nursing students from nursing school of a university in China. Students from parallel classes 1, 2 and 3 (45 students) were selected as experimental group, while students from parallel classes 4, 5 and 6 (48 students) were selected as control group. The control group completed the in-person simulation, while the experimental group was required to complete both virtual simulation and in-person simulation. The students\' performance in in-person simulation was evaluated by the teachers according to a demonstrating checklist. After simulation, Students were invited to answer the Students\' Satisfaction and Self-confidence in Learning Scale (SSS), Educational Practices in Simulation Scale (EPSS) and Clinical Learning Environment Comparison Survey (CLECS). A descriptive qualitative study was conducted in qualitative phase. Ten students were recruited by a purposive sampling method from the experimental group and were interviewed by the researcher. A semi-structured interview method was used to conduct in-depth interviews with them.
RESULTS: The mean score of the students\' performance in the experimental group was higher than that in the control group (63.00 vs 57.67). There were no significant differences in learning satisfaction, self-confidence and simulated practice score (except cooperation dimension) between the two groups (P>0.05). For experimental group, the total CLECS score in in-person simulation was higher than that in virtual simulation, which was 84.98±12.50 and 72.58±13.04 respectively and the difference was statistically significant (t=5.270, p<0.001). Ten students were interviewed in the qualitative phase. Through the interview, we have learned that students believed that virtual simulation combined with in-person simulation is helpful to enhance their knowledge, improve their learning confidence and help them develop non-technical skills (i.e., decision-making and critical thinking).
CONCLUSIONS: In-person simulation is the preferred form of simulation and virtual simulation is a beneficial supplement to in-person simulation. The combination of the two is suggested to be introduced into the simulation curriculum for undergraduate nursing students.

BACKGROUND: The beneficial effect of simulation experience on nursing students is well established in the literature. However, an accurate simulation modality to help professional nurses enhance their clinical competence and expertise remains unexplored. The current study evaluated and contrasted the impact of two simulation modalities on nurses\' knowledge, abilities, self-efficacy, confidence, and satisfaction following a simulated clinical experience caring for chemotherapy patients.
METHODS: A quasi-experimental research design was employed in this study. The participants were divided into group A, comprising nurses exposed to the high-fidelity simulation, and group B, comprising nurses exposed to the virtual simulation.
RESULTS: The study found that nurses exposed to high-fidelity simulation and virtual simulation gained a high standard of knowledge and skills. The nurses\' post-test and post-objective structured clinical examination (OSCE) scores drastically increased after simulation exposure compared to their pre-test and pre-OSCE scores. For the group exposed to high-fidelity simulation, the mean differences were - 19.65 (pre- and post-test) and 23.85 (pre- and post-OSCE), while for the group exposed to virtual simulation, the mean differences were - 22.42 (pre- and post-test) and 20.63 (pre- and post-OSCE). All p-values indicated significant differences < 0.001. Moreover, both groups exhibited high self-efficacy, confidence, and satisfaction levels after the simulation experience. The outcomes of both simulation modalities regarding self-efficacy, confidence, and satisfaction levels indicate no significant difference, as supported by p-values of > 0.05.
CONCLUSIONS: High-fidelity simulation and virtual simulation training effectively and efficiently advance nurses\' professional competence. The nurses exposed to high-fidelity simulation and virtual simulation gained high levels of knowledge and skills. Additionally, it increased their sense of happiness, self-worth, and self-efficacy. The simulation approach will be a potent instrument for improving nurses\' competency and fully developing their sense of expertise. Therefore, developing policies adopting simulation as part of their professional development will ensure patient safety and improve health outcomes.

BACKGROUND: Cardiac Arrest (CA) is one of the leading causes of death, either inside or outside hospitals. Recently, the use of creative teaching strategies, such as simulation, has gained popularity in Cardio Pulmonary Resuscitation (CPR) instruction. This study aimed to assess the effect of High-Fidelity Simulation (HFS) training on nursing students\' self-efficacy, attitude, and anxiety in the context of Advanced Cardiac Life Support (ACLS).
METHODS: The study design is quasi-experimental employing a pre-test and post-test approach during April and May 2023. A convenient sample of 60 undergraduate nursing students in a 4-year class from a nursing college at the Arab American University/ Palestine (AAUP) participated in this study. The data were analyzed using a paired sample t-test in SPSS program version 26. Three data collection tools were used pre- and post-intervention; the Resuscitation Self-Efficacy Scale (RSES), The Attitudinal instrument, and the State Anxiety Inventory (SAI).
RESULTS: The total number of nursing students was 60, out of them (56.7%) were female, while the mean age was (22.2) years. Improvements were seen in all four domains of self-efficacy following HFS training: recognition, debriefing, recording, responding and rescuing, and reporting. (t (59) = 26.80, p < 0.001, confidence interval [29.32, 34.05]). After receiving HFS training on ACLS, the post-intervention for the same group attitude scores significantly increased from 32.83 (SD = 15.35) to 54.58 (SD = 8.540) for emotion, from 6.72 (SD = 2.44) to 10.40 (SD = 1.40) for behavior, and from 7.03 (SD = 2.03) to 10.33 (SD = 1.42) for cognitive. The anxiety level decreased post-simulation from 3.53 (SD = 0.3) to 2.14 (SD = 0.65), which was found to be statistically significant (t(59) = 16.68, p < 0.001, 95% CI [1.22 to 1.55]). Female students (M = 73.18), students who observed a real resuscitation (M = 71.16), and who were satisfied with their nursing major (M = 72.17) had significantly higher self-efficacy scores post-simulation.
CONCLUSIONS: The HFS can be recommended as an effective training strategy among nursing students. The ACLS training-based HFS was effective in improving the students\' self-efficacy and attitudes and decreasing their anxiety.

Guidelines recommend using viscoelastic coagulation tests to guide coagulation management, but interpreting the results remains challenging. Visual Clot, a 3D animated blood clot, facilitates interpretation through a user-centered and situation awareness-oriented design.
This study aims to compare the effects of Visual Clot versus conventional viscoelastic test results (rotational thrombelastometry [ROTEM] temograms) on the coagulation management performance of anesthesia teams in critical bleeding situations.
We conducted a prospective, randomized, high-fidelity simulation study in which anesthesia teams (consisting of a senior anesthesiologist, a resident anesthesiologist, and an anesthesia nurse) managed perioperative bleeding scenarios. Teams had either Visual Clot or ROTEM temograms available to perform targeted coagulation management. We analyzed the 15-minute simulations with post hoc video analysis. The primary outcome was correct targeted coagulation therapy. Secondary outcomes were time to targeted coagulation therapy, confidence, and workload. In addition, we have conducted a qualitative survey on user acceptance of Visual Clot. We used Poisson regression, Cox regression, and mixed logistic regression models, adjusted for various potential confounders, to analyze the data.
We analyzed 59 simulations. Teams using Visual Clot were more likely to deliver the overall targeted coagulation therapy correctly (rate ratio 1.56, 95% CI 1.00-2.47; P=.05) and administer the first targeted coagulation product faster (hazard ratio 2.58, 95% CI 1.37-4.85; P=.003). In addition, participants showed higher decision confidence with Visual Clot (odds ratio 3.60, 95% CI 1.49-8.71; P=.005). We found no difference in workload (coefficient -0.03, 95% CI -3.08 to 2.88; P=.99).
Using Visual Clot led to a more accurate and faster-targeted coagulation therapy than using ROTEM temograms. We suggest that relevant viscoelastic test manufacturers consider augmenting their complex result presentation with intuitive, easy-to-understand visualization to ease users\' burden from unnecessary cognitive load and enhance patient care.

暂无摘要。

BACKGROUND: The use of high-fidelity simulation (HFS) methods provides probable benefits and advantages for nursing students to retain knowledge, acquire skills, improve satisfaction, and gain self-confidence in a safe, realistic and supportive environment.
OBJECTIVE: To evaluate the effect of HFS methods to develop Foley catheterization knowledge, skills, satisfaction and self-confidence among novice nursing students when compared to low-fidelity simulation (LFS). The specific aim was to examine the effects of outcome variables between the intervention group and the control group, through multi-group path analysis.
METHODS: A randomized controlled trial was designed.
METHODS: 80 nursing students were randomly assigned to the HFS group (high-fidelity manikin and scenario) and the LFS group (female catheterization simulator) at a nursing faculty between May and July 2019 in Türkiye.
METHODS: The intervention group experienced HFS and the control group experienced LFS in order to learn Foley catheterization. Students\' knowledge was evaluated before and after the intervention, while affective and psychomotor skills, and satisfaction and self-confidence in learning were evaluated after the intervention.
RESULTS: The HFS group had better skill performance and significantly higher self-confidence in learning than the LFS group. While each group had a high level of knowledge, affective skills and satisfaction, there was no significant difference between the groups\' mean scores.
CONCLUSIONS: The HFS and scenario improved the knowledge, affective and psychomotor skills, satisfaction and self-confidence of novice nursing students on Foley catheterization. When compared to LFS, HFS had more advantages for the development of psychomotor skills and self-confidence in learning.