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      Formación en la asistencia al paciente crítico y politraumatizado: papel de la simulación clínica Translated title: Training in the care of the critical and multiple-injured patient: role of clinical simulation

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          Abstract

          La simulación clínica está surgiendo como un nuevo instrumento educativo para aprender y entrenar diferentes habilidades médicas. Está concebida como un novedoso método que integra conocimiento científico y factores humanos. La experiencia con estos sistemas es hasta ahora limitada, pero está siendo ampliamente aceptada, ya que parece acelerar la adquisición de habilidades y conocimientos en un ambiente seguro, es decir, sin riesgo para el paciente; si bien su efecto en el rendimiento clínico aún no ha sido validado. Hay dos tipos de simuladores para cuidados intensivos: de pantalla y simuladores de paciente a escala real (SER). Estos sistemas permiten simular distintas situaciones que requieren la aplicación de protocolos de actuación o el manejo de nuevos fármacos en la práctica clínica, fomentando el uso racional de recursos en la asistencia urgente del paciente crítico y politraumatizado. Los factores limitantes que impiden la expansión de la simulación para el entrenamiento clínico son su alto coste, los recursos humanos necesarios y las dificultades para valorar la efectividad del entrenamiento en situaciones reales.

          Translated abstract

          Clinical simulation is suggested as a new educational instrument to learn and train in different medical skills. It is conceived as a new method that integrates scientific knowledge and human factors. Experience with these systems has been limited up to now, but it is now being widely accepted since it seems to accelerate acquisition of skills and knowledge in a safe setting, that is, without risk for the patient. However, its effect on clinical performance has not been validated yet. They are two types of simulators for intensive cares: screen based and human patient simulator (HPS). These systems make it possible to simulate different situations that require the application of action protocols or the management of new drugs in the clinical practice, promoting the rational use of resources in urgent care of the critical and multiple-injured patients. The limiting factors that prevent the expansion of the simulation for clinical training are its high cost, human resources needed, and the difficulties to assess the effectiveness of the training in real situations.

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          Assessment of clinical performance during simulated crises using both technical and behavioral ratings.

          Techniques are needed to assess anesthesiologists' performance when responding to critical events. Patient simulators allow presentation of similar crisis situations to different clinicians. This study evaluated ratings of performance, and the interrater variability of the ratings, made by multiple independent observers viewing videotapes of simulated crises. Raters scored the videotapes of 14 different teams that were managing two scenarios: malignant hyperthermia (MH) and cardiac arrest. Technical performance and crisis management behaviors were rated. Technical ratings could range from 0.0 to 1.0 based on scenario-specific checklists of appropriate actions. Ratings of 12 crisis management behaviors were made using a five-point ordinal scale. Several statistical assessments of interrater variability were applied. Technical ratings were high for most teams in both scenarios (0.78 +/- 0.08 for MH, 0.83 +/- 0.06 for cardiac arrest). Ratings of crisis management behavior varied, with some teams rated as minimally acceptable or poor (28% for MH, 14% for cardiac arrest). The agreement between raters was fair to excellent, depending on the item rated and the statistical test used. Both technical and behavioral performance can be assessed from videotapes of simulations. The behavioral rating system can be improved; one particular difficulty was aggregating a single rating for a behavior that fluctuated over time. These performance assessment tools might be useful for educational research or for tracking a resident's progress. The rating system needs more refinement before it can be used to assess clinical competence for residency graduation or board certification.
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            Demonstration of high-fidelity simulation team training for emergency medicine.

            Emergency medicine (EM) presents many cognitive, social, and systems challenges to practitioners. Coordination and communication under stress between and among individuals and teams representing a number of disciplines are critical for optimal care of the patient. The specialty is characterized by uncertainty, complexity, rapidly shifting priorities, a dependence on teamwork, and elements common to other risky domains such as perioperative medicine and aviation. High-fidelity simulators have had a long tradition in aviation, and in the past few years have begun to have a significant impact in anesthesiology. A national, multicenter research program to document the costs of teamwork failures in EM and provide a remedy in the form of an Emergency Team Coordination Course has developed to the point that high-fidelity medical simulators will be added to the hands-on training portion of the course. This paper describes an evolving collaborative effort by members of the Center for Medical Simulation, the Harvard Emergency Medicine Division, and the MedTeams program to design, demonstrate, and refine a high-fidelity EM simulation course to improve EM clinician performance, increase patient safety, and decrease liability. The main objectives of the paper are: 1) to present detailed specifications of tools and techniques for high-fidelity medical simulation; 2) to share the results of a proof-of-concept EM simulation workshop introducing multiple mannequin/ three-patient scenarios; and 3) to focus on teamwork applications. The authors hope to engage the EM community in a wide-ranging discussion and handson exploration of these methods.
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              Patient simulation for training basic and advanced clinical skills.

              Patient simulators are increasingly used in the education and training of healthcare professionals. This paper describes the history of human patient simulator development, the features of contemporary simulators, the acquisition of basic and advanced clinical skills using patient simulators, and the benefits, cost, limitations and effectiveness of this innovative learning modality. The development of human patient simulators began in the late 1960s, and accelerated in the late 1980s and early 1990s. Several simulator systems are now professionally manufactured, commercially available, and used at hundreds of medical centres, universities and colleges in the USA and throughout the world. Contemporary patient simulators have many clinical features, and look and respond to interventions with ever-increasing degrees of realism because sophisticated physiological and pharmacological models automatically control many features. Simulators are used to teach basic skills, such as respiratory physiology and cardiovascular haemodynamics, and advanced clinical skills, e.g. management of difficult airways, tension pneumothorax, pulmonary embolism and shock. The simulation laboratory offers distinct educational advantages, especially for learning how to recognise and to treat rare, complex, clinical problems. Costs of simulator-based educational programmes include facility, equipment and personnel. Current limitations include clinical realism of the patient manikin and faculty development.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                medinte
                Medicina Intensiva
                Med. Intensiva
                Elsevier España, S.L. (Barcelona )
                0210-5691
                May 2007
                : 31
                : 4
                : 187-193
                Affiliations
                [1 ] Hospital Universitario Maqués de Valdecilla
                [2 ] Fundación Marcelino Botín Spain
                [3 ] Hospital Universitario Maqués de Valdecilla
                [4 ] Hospital Universitario Maqués de Valdecilla
                Article
                S0210-56912007000400005
                10.1016/S0210-5691(07)74805-2
                2b3d998c-3f25-41f4-bfe3-712ff64bfaa6

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                CRITICAL CARE MEDICINE
                EMERGENCY MEDICINE

                Emergency medicine & Trauma
                simulation,training,medical education,clinical performance,patient's safety,multiple injury,intensive medicine,simulación,entrenamiento,educación médica,rendimiento clínico,seguridad del paciente,politraumatizado,medicina intensiva

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