- Email: [email protected]
Introducing Low-Cost Simulation Equipment for Simulation-Based Team Training
Clinical Simulation in Nursing (2020) 38, 18-22
www.elsevier.com/locate/ecsn
Innovations in Simulation
Introducing Low-Cost Simulation Equipment for Simulation-Based Team Training €cke, MD*, Lorenz Grigull, MD, Birte S€anger, BA, Lea P. Berndt, Urs Mu Henrike Wittenbecher, Cornelia Schwarzbard, RN, Alina V. Bak, RN, €hler, RN, Fabian Pittau, RN, Petra Tiroke, MD Annika Ko Hannover Medical School, Department of Pediatric Hematology and Oncology, Hannover, Germany KEYWORDS simulation-based team training; simulation-based medical training; cost-efficiency; crew resource management; simulation equipment
Abstract: Teamwork and interdisciplinary collaboration play an import role especially in pediatric oncology. Currently, team training workshops integrate simulation-based education to a varying extent. Unfortunately, high-end equipment is costly and therefore not accessible to all educators. To overcome this financial barrier, the implementation of low-cost live video and audio equipment for simulation and debriefing in pediatric oncology was investigated. Here, an easy-to-adopt setup which proved effective in simulation-based team trainings in pediatrics is introduced. Cite this article: M€ucke, U., Grigull, L., S€anger, B., Berndt, L. P., Wittenbecher, H., Schwarzbard, C., Bak, A. V., K€ ohler, A., Pittau, F., & Tiroke, P. (2020, January). Introducing low-cost simulation equipment for simulationbased team training. Clinical Simulation in Nursing, 38(C), 18-22. https://doi.org/10.1016/ j.ecns.2019.09.001. Ó 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Health-care work offers medical and communicative challenges to interdisciplinary teams (Mueller, 2014). Errors and critical incidents can endanger both staff members and patients. Therefore, many hospitals try to improve their team’s performance by simulation-based education. A department of pediatric oncology in a university hospital of a major city in Germany sees approximately 90 to 100 new patients per year. This means that invasive diagnostic procedures (lumbar puncture, bone marrow aspiration), intense therapies (chemotherapy, radiation), and various complications (e.g., anaphylaxis, seizures, kidney function alterations) present daily challenges for staff, patients, and families. In 2016, an interdisciplinary workshop series, including nurses, physicians, medical students, was introduced to improve knowledge about * Corresponding author: [email protected] (U. M€ucke).
these topics as well as handling thereof. The workshop series is divided into three modules ranging from basic knowledge and techniques to advanced scenarios for experienced learners. Simulation-based team training (SBTT) in our simulation center and in-house training at other hospitals are crucial components of the workshop series. Here, one group of learners performs a simulated scenario (e.g., anaphylactic reaction) while the second group is watching from an adjoining room. Afterwards, both groups meet for a debriefing session to enhance the learning experience. The scenario is designed by educators who also act as standardized patients and guide the debriefing. This form of simulation and debriefing can be challenging because of the technical necessities (expensive equipment, technical knowledge, and properly equipped facilities). This is why the aim of the project was to compile a lowcost technical setup which could be placed in a standard
1876-1399/$ - see front matter Ó 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.ecns.2019.09.001
Introducing Low-Cost Simulation Equipment patient room or any other environment and which would work well under suboptimal conditions, such as an unstable Wi-Fi connection while broadcasting from the simulation room (SR) to the observation room (OR). In SBTT, video and audio equipment is frequently used in various surroundings reaching from simple classrooms Key Points to highly specialized moun Modern technical tain weather chambers equipment is cost(Pietsch, Ney, Kreuzer, intensive and not Berner, & Lischke, 2017). affordable for all For technically supported educators. SBTT, different components We introduce a lowhave to be combined. Video cost setup for livetechnique can be used for devideo and audio techbriefing after the scenario, nique in simulation. for research purposes, or as The components are live-broadcast to observe portable and indepenthe scenario from a second dent of specialized room (OR) (‘‘Introducing training centers. INACSL Standards of Best Practice: Simulation SM Operations,’’ 2017). This is often necessary as mirror windows between the SR and the OR are frequently absent (St.Pierre & Breuer, 2018). Different types of cameras offer a wide range of features, angles, and image qualities. The video signal can be sent from the SR to the OR by cable or via Wi-Fi. Audio technique includes recording devices and a variety of speakers. Microphones can be placed in the SR or attached to the active participants. The budget available for such equipment differs enormously (Kardong-Edgren, Lungstrom, & Bendel, 2009). High-fidelity manikins are often used in resuscitation training and anesthesia (Flentje, Eismann, Sieg, Friedrich, & Breuer, 2018). Some specialties can do without realistic patient models, but adequate technology is needed to monitor participants while simulation scenarios are performed Table 1
19 (Mahling et al., 2015). At our institution, workshop participants looked on simulation scenarios favorably but expressed a desire for technically supported team-orientated debriefing. Because commercially available video and audio solutions were beyond the means of our project, we sought for affordable alternatives. To implement low-cost simulation equipment for SBTT at our institution, an extensive literature review was performed and discussions with trainers from the local emergency department experienced in simulation were held. We determined that the most import criteria for the selection of components were ‘‘lowest price possible,’’ ‘‘independence of wireless network,’’ ‘‘easy to use,’’ ‘‘multiuse devices to reduce running costs,’’ and ‘‘customizable to individual needs.’’
Components of Our Low-Cost Simulation Equipment The setup contains video and audio components offering different means of application to the educators, such as the iPad which can be used for video-recording and mobile debriefing sessions or presentations. The components are shown in Table 1. An overview of the setup is given in Figure 1. The scenario takes place in the SR (see Figure 2). It is filmed by an iPad on a tripod while a high-quality studio microphone records the sound. The audio-signal is sent via cable to an adapter connected to the iPad. This adapter is crucial, as standard video software does not include simultaneous recording and playing of audio signals (so-called audio-monitoring). The iRig Microphone adapter and the application FilMic on the iPad are used. A FilMic Pro Remote version includes a remote-control function. It can be used by the instructors to control the recording device in the SR from the OR (second iPad necessary). Both the video and audio signals are
Components Used in the Low-Cost Simulation Equipment
Category Video Camera Broadcasting Accessories
Software Audio Microphone Broadcasting Accessories Software Total
Device (Example)
Price (USD, Approximately)
IpadÒ -9,700 , Wi-Fi 128 G CableName (HDMI cable 20 m) Adapter (AppleÒ Lightning to HDMI Adapter) Adapter#(ipowÒ iPad Tripod Mount Adapter) Tripod* (HamaÒ Fotostativ Action 165 3D) Extension Cableþ (Cordial CTM 3 FM-BL, 3 m, XLR female/male, neutrik plug) FiLMiCÒ Pro Camera Kit (APP)
550 USD 35 USD 60 USD # 12 USD * 40 USD þ 17 USD
IK Multimedia iRigÒ Mic Studio XLR Aux.-cable (20 m length, stereo jack) Adapter (IK Multimedia iRigÒ Pre) FiLMiCÒ Pro Camera Kit APP
20 USD 115 USD 17 USD 40 USD Approx. 900 USD
pp 18-22 Clinical Simulation in Nursing Volume 38
Introducing Low-Cost Simulation Equipment
20
Figure 1 Setup of the simulation technique: components in the simulation room (SR) and observation room (OR) are displayed. Connections via cable are illustrated (.). 1: iPad camera; 2: microphone; 3: screen as an alternative to mirror wall; 4: speaker; #: connection device for audio-monitoring; *: mirror-wall between two rooms.
transmitted from the SR to the OR by cable. A wireless network connection is not needed but may be used if available. In the OR, the observers can either watch the scenario through a mirror walldif existentdor use a standard screen with HDMI/VGA input (see Figure 3). The audio signal from the SR is played back by a speaker in the
OR. Comparable whole-in-one systems are for sale by different companies and cost up to $25 000 for a basic setup. In comparison, the setup introduced here costs about $900 (see Table 1). It focuses on a reasonable priceperformance ratio. Another advantage is the independence from Wi-Fi or other local network systems. Due to
Figure 2 An iPad is used for video-recording in the simulation room. The audio and video signals are transmitted by cables. The essential adapter for audio monitoring is connected to the iPad and the studio microphone.
pp 18-22 Clinical Simulation in Nursing Volume 38
Introducing Low-Cost Simulation Equipment
Figure 3
21
The observation room contains equipment for live observation. Beamer and speaker receive signals by cable without delay.
individual component selection, it is adaptable to local requirements (e.g., length of cables). Upgrades of microphones and iPads are possible. The components are easily portable, and no great technical experience is necessary for installation. In addition, maintenance costs are low because of the absence of complex software.
Evaluation of Participants’ Experience With the Equipment A pre-post evaluation survey was conducted with experienced learners using low-cost simulation equipment in different scenarios (simulated emergency, breaking bad news, delivering feedback as a part of crew resource Table 2 Prior-Post Assessment of 69 Participants Experiencing Low-Cost Simulation Equipment in a Workshop Statement ‘‘I feel confident in breaking bad news’’ ‘‘I feel confident in delivering feedback’’ ‘‘I feel confident to ask for feedback’’ ‘‘I feel confident to overcome barriers of hierarchy’’
Prior Workshop Mean (SD)
Post Workshop Mean (SD)
3.8 (1.0)
2.1 (0.6)
2.7 (0.8)
1.8 (0.5)
3.0 (1.0)
1.8 (0.6)
2.9 (1.0)
2.2 (0.7)
Results from a survey using 5-point Likert scale (1 ¼ total agreement, 5 ¼ total disagreement).
management). 69 of 76 (91%) participants completed both questionnaires before and after participating in a workshop module using low-cost simulation equipment. The questionnaire uses a 5-Point Likert scale to measure the degree of agreement to different statements, as well as free text comments. Improvements were measured between preassessment and postassessment, especially confidence in breaking bad news, delivering of feedback, and overcoming hierarchy improvements were documented (see Table 2). Overall satisfaction was high, with a recommendation rate of 100%. Data on workshop experiences before the implementation of the equipment are lacking.
Limitations of the Equipment The setup has several limitations, including educatordependent factors and technical details. The equipment is not available as a bundle, resulting in a more time-consuming process of purchasing, as each individual component must be secured separately. The assembly is not intuitive but feasible with moderate technical knowledge. Multicamera setups are not possible because the video software does not provide this option. However, basic team training scenarios are usually possible without multiple perspectives. An instructor voice played back in the SR mimicking the patient’s voice is not integrated. The setup introduced here is optimized for the Apple iPad. Other tablets would require modifications. Evaluation of the SBTT using the low-cost composition in detail is still ongoing. Further evaluation needs to focus on specific learner experiences and its transferability to daily hospital routine. pp 18-22 Clinical Simulation in Nursing Volume 38
Introducing Low-Cost Simulation Equipment Altogether, we propose a low-cost simulation technique equipment for live-videoeassisted SBTT. It proved highly functional in workshops with 76 medical students, nurses, and interdisciplinary teams. Next steps include the closing of technical gaps (e.g., integration of a patient’s voice played in the SR) and the evaluation of the setup’s influence on the learning experience in pediatric oncology.
Acknowledgments This work was made possible with the financial support of ‘‘Verein f€ ur Krebskranke Kinder Hannover e.V.’’ and the ‘‘Deutsche Kinderkrebsstiftung’’. The authors acknowledge Anna Zychlinsky Scharff and David Dieckmann for extensive proofreading.
References Flentje, M., Eismann, H., Sieg, L., Friedrich, L., & Breuer, G. (2018). Simulation als Fortbildungsmethode zur Professionalisierung von
22 Teams. AINS - An€asthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 53(01), 20-33. https://doi.org/10.1055/s-0043-105261. Introducing INACSL Standards of Best Practice: Simulation SM Operations. (2017). Clinical Simulation in Nursing, 13(12), 680. https://doi. org/10.1016/j.ecns.2017.10.004. Kardong-Edgren, S., Lungstrom, N., & Bendel, R. (2009). VitalSimÒ versus SimManÒ: A comparison of BSN student test scores, knowledge retention, and satisfaction. Clinical Simulation in Nursing, 5(3), e105e111. https://doi.org/10.1016/j.ecns.2009.01.007. Mahling, M., M€unch, A., Castan, C., Schubert, P., Haffner, L., Griewatz, J., ., & Reutershan, J. (2015). Building an audio/videofeedback system for simulation training in medical education. Bio-Algorithms and Med-Systems, 11(2), 89-99. https://doi.org/10.1515/bams2015-0010. Mueller, B. U. (2014). Quality and safety in pediatric hematology/oncology. Pediatric Blood & Cancer, 61(6), 966-969. https://doi.org/10. 1002/pbc.24946. Pietsch, U., Ney, L., Kreuzer, O., Berner, A., & Lischke, V. (2017). Helicopter emergency medical service simulation training in the extreme: Simulation-based training in a mountain weather chamber. Air Medical Journal, 36(4), 193-194. https://doi.org/10.1016/j.amj. 2017.03.004. St.Pierre, M., & Breuer, G. (2018). In Pierre, M. St., & Breuer, G. (Eds.), Simulation in der Medizin (2nd ed.). Berlin, Heidelberg: Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-662-54566-9.
pp 18-22 Clinical Simulation in Nursing Volume 38
www.elsevier.com/locate/ecsn
Innovations in Simulation
Introducing Low-Cost Simulation Equipment for Simulation-Based Team Training €cke, MD*, Lorenz Grigull, MD, Birte S€anger, BA, Lea P. Berndt, Urs Mu Henrike Wittenbecher, Cornelia Schwarzbard, RN, Alina V. Bak, RN, €hler, RN, Fabian Pittau, RN, Petra Tiroke, MD Annika Ko Hannover Medical School, Department of Pediatric Hematology and Oncology, Hannover, Germany KEYWORDS simulation-based team training; simulation-based medical training; cost-efficiency; crew resource management; simulation equipment
Abstract: Teamwork and interdisciplinary collaboration play an import role especially in pediatric oncology. Currently, team training workshops integrate simulation-based education to a varying extent. Unfortunately, high-end equipment is costly and therefore not accessible to all educators. To overcome this financial barrier, the implementation of low-cost live video and audio equipment for simulation and debriefing in pediatric oncology was investigated. Here, an easy-to-adopt setup which proved effective in simulation-based team trainings in pediatrics is introduced. Cite this article: M€ucke, U., Grigull, L., S€anger, B., Berndt, L. P., Wittenbecher, H., Schwarzbard, C., Bak, A. V., K€ ohler, A., Pittau, F., & Tiroke, P. (2020, January). Introducing low-cost simulation equipment for simulationbased team training. Clinical Simulation in Nursing, 38(C), 18-22. https://doi.org/10.1016/ j.ecns.2019.09.001. Ó 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Health-care work offers medical and communicative challenges to interdisciplinary teams (Mueller, 2014). Errors and critical incidents can endanger both staff members and patients. Therefore, many hospitals try to improve their team’s performance by simulation-based education. A department of pediatric oncology in a university hospital of a major city in Germany sees approximately 90 to 100 new patients per year. This means that invasive diagnostic procedures (lumbar puncture, bone marrow aspiration), intense therapies (chemotherapy, radiation), and various complications (e.g., anaphylaxis, seizures, kidney function alterations) present daily challenges for staff, patients, and families. In 2016, an interdisciplinary workshop series, including nurses, physicians, medical students, was introduced to improve knowledge about * Corresponding author: [email protected] (U. M€ucke).
these topics as well as handling thereof. The workshop series is divided into three modules ranging from basic knowledge and techniques to advanced scenarios for experienced learners. Simulation-based team training (SBTT) in our simulation center and in-house training at other hospitals are crucial components of the workshop series. Here, one group of learners performs a simulated scenario (e.g., anaphylactic reaction) while the second group is watching from an adjoining room. Afterwards, both groups meet for a debriefing session to enhance the learning experience. The scenario is designed by educators who also act as standardized patients and guide the debriefing. This form of simulation and debriefing can be challenging because of the technical necessities (expensive equipment, technical knowledge, and properly equipped facilities). This is why the aim of the project was to compile a lowcost technical setup which could be placed in a standard
1876-1399/$ - see front matter Ó 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.ecns.2019.09.001
Introducing Low-Cost Simulation Equipment patient room or any other environment and which would work well under suboptimal conditions, such as an unstable Wi-Fi connection while broadcasting from the simulation room (SR) to the observation room (OR). In SBTT, video and audio equipment is frequently used in various surroundings reaching from simple classrooms Key Points to highly specialized moun Modern technical tain weather chambers equipment is cost(Pietsch, Ney, Kreuzer, intensive and not Berner, & Lischke, 2017). affordable for all For technically supported educators. SBTT, different components We introduce a lowhave to be combined. Video cost setup for livetechnique can be used for devideo and audio techbriefing after the scenario, nique in simulation. for research purposes, or as The components are live-broadcast to observe portable and indepenthe scenario from a second dent of specialized room (OR) (‘‘Introducing training centers. INACSL Standards of Best Practice: Simulation SM Operations,’’ 2017). This is often necessary as mirror windows between the SR and the OR are frequently absent (St.Pierre & Breuer, 2018). Different types of cameras offer a wide range of features, angles, and image qualities. The video signal can be sent from the SR to the OR by cable or via Wi-Fi. Audio technique includes recording devices and a variety of speakers. Microphones can be placed in the SR or attached to the active participants. The budget available for such equipment differs enormously (Kardong-Edgren, Lungstrom, & Bendel, 2009). High-fidelity manikins are often used in resuscitation training and anesthesia (Flentje, Eismann, Sieg, Friedrich, & Breuer, 2018). Some specialties can do without realistic patient models, but adequate technology is needed to monitor participants while simulation scenarios are performed Table 1
19 (Mahling et al., 2015). At our institution, workshop participants looked on simulation scenarios favorably but expressed a desire for technically supported team-orientated debriefing. Because commercially available video and audio solutions were beyond the means of our project, we sought for affordable alternatives. To implement low-cost simulation equipment for SBTT at our institution, an extensive literature review was performed and discussions with trainers from the local emergency department experienced in simulation were held. We determined that the most import criteria for the selection of components were ‘‘lowest price possible,’’ ‘‘independence of wireless network,’’ ‘‘easy to use,’’ ‘‘multiuse devices to reduce running costs,’’ and ‘‘customizable to individual needs.’’
Components of Our Low-Cost Simulation Equipment The setup contains video and audio components offering different means of application to the educators, such as the iPad which can be used for video-recording and mobile debriefing sessions or presentations. The components are shown in Table 1. An overview of the setup is given in Figure 1. The scenario takes place in the SR (see Figure 2). It is filmed by an iPad on a tripod while a high-quality studio microphone records the sound. The audio-signal is sent via cable to an adapter connected to the iPad. This adapter is crucial, as standard video software does not include simultaneous recording and playing of audio signals (so-called audio-monitoring). The iRig Microphone adapter and the application FilMic on the iPad are used. A FilMic Pro Remote version includes a remote-control function. It can be used by the instructors to control the recording device in the SR from the OR (second iPad necessary). Both the video and audio signals are
Components Used in the Low-Cost Simulation Equipment
Category Video Camera Broadcasting Accessories
Software Audio Microphone Broadcasting Accessories Software Total
Device (Example)
Price (USD, Approximately)
IpadÒ -9,700 , Wi-Fi 128 G CableName (HDMI cable 20 m) Adapter (AppleÒ Lightning to HDMI Adapter) Adapter#(ipowÒ iPad Tripod Mount Adapter) Tripod* (HamaÒ Fotostativ Action 165 3D) Extension Cableþ (Cordial CTM 3 FM-BL, 3 m, XLR female/male, neutrik plug) FiLMiCÒ Pro Camera Kit (APP)
550 USD 35 USD 60 USD # 12 USD * 40 USD þ 17 USD
IK Multimedia iRigÒ Mic Studio XLR Aux.-cable (20 m length, stereo jack) Adapter (IK Multimedia iRigÒ Pre) FiLMiCÒ Pro Camera Kit APP
20 USD 115 USD 17 USD 40 USD Approx. 900 USD
pp 18-22 Clinical Simulation in Nursing Volume 38
Introducing Low-Cost Simulation Equipment
20
Figure 1 Setup of the simulation technique: components in the simulation room (SR) and observation room (OR) are displayed. Connections via cable are illustrated (.). 1: iPad camera; 2: microphone; 3: screen as an alternative to mirror wall; 4: speaker; #: connection device for audio-monitoring; *: mirror-wall between two rooms.
transmitted from the SR to the OR by cable. A wireless network connection is not needed but may be used if available. In the OR, the observers can either watch the scenario through a mirror walldif existentdor use a standard screen with HDMI/VGA input (see Figure 3). The audio signal from the SR is played back by a speaker in the
OR. Comparable whole-in-one systems are for sale by different companies and cost up to $25 000 for a basic setup. In comparison, the setup introduced here costs about $900 (see Table 1). It focuses on a reasonable priceperformance ratio. Another advantage is the independence from Wi-Fi or other local network systems. Due to
Figure 2 An iPad is used for video-recording in the simulation room. The audio and video signals are transmitted by cables. The essential adapter for audio monitoring is connected to the iPad and the studio microphone.
pp 18-22 Clinical Simulation in Nursing Volume 38
Introducing Low-Cost Simulation Equipment
Figure 3
21
The observation room contains equipment for live observation. Beamer and speaker receive signals by cable without delay.
individual component selection, it is adaptable to local requirements (e.g., length of cables). Upgrades of microphones and iPads are possible. The components are easily portable, and no great technical experience is necessary for installation. In addition, maintenance costs are low because of the absence of complex software.
Evaluation of Participants’ Experience With the Equipment A pre-post evaluation survey was conducted with experienced learners using low-cost simulation equipment in different scenarios (simulated emergency, breaking bad news, delivering feedback as a part of crew resource Table 2 Prior-Post Assessment of 69 Participants Experiencing Low-Cost Simulation Equipment in a Workshop Statement ‘‘I feel confident in breaking bad news’’ ‘‘I feel confident in delivering feedback’’ ‘‘I feel confident to ask for feedback’’ ‘‘I feel confident to overcome barriers of hierarchy’’
Prior Workshop Mean (SD)
Post Workshop Mean (SD)
3.8 (1.0)
2.1 (0.6)
2.7 (0.8)
1.8 (0.5)
3.0 (1.0)
1.8 (0.6)
2.9 (1.0)
2.2 (0.7)
Results from a survey using 5-point Likert scale (1 ¼ total agreement, 5 ¼ total disagreement).
management). 69 of 76 (91%) participants completed both questionnaires before and after participating in a workshop module using low-cost simulation equipment. The questionnaire uses a 5-Point Likert scale to measure the degree of agreement to different statements, as well as free text comments. Improvements were measured between preassessment and postassessment, especially confidence in breaking bad news, delivering of feedback, and overcoming hierarchy improvements were documented (see Table 2). Overall satisfaction was high, with a recommendation rate of 100%. Data on workshop experiences before the implementation of the equipment are lacking.
Limitations of the Equipment The setup has several limitations, including educatordependent factors and technical details. The equipment is not available as a bundle, resulting in a more time-consuming process of purchasing, as each individual component must be secured separately. The assembly is not intuitive but feasible with moderate technical knowledge. Multicamera setups are not possible because the video software does not provide this option. However, basic team training scenarios are usually possible without multiple perspectives. An instructor voice played back in the SR mimicking the patient’s voice is not integrated. The setup introduced here is optimized for the Apple iPad. Other tablets would require modifications. Evaluation of the SBTT using the low-cost composition in detail is still ongoing. Further evaluation needs to focus on specific learner experiences and its transferability to daily hospital routine. pp 18-22 Clinical Simulation in Nursing Volume 38
Introducing Low-Cost Simulation Equipment Altogether, we propose a low-cost simulation technique equipment for live-videoeassisted SBTT. It proved highly functional in workshops with 76 medical students, nurses, and interdisciplinary teams. Next steps include the closing of technical gaps (e.g., integration of a patient’s voice played in the SR) and the evaluation of the setup’s influence on the learning experience in pediatric oncology.
Acknowledgments This work was made possible with the financial support of ‘‘Verein f€ ur Krebskranke Kinder Hannover e.V.’’ and the ‘‘Deutsche Kinderkrebsstiftung’’. The authors acknowledge Anna Zychlinsky Scharff and David Dieckmann for extensive proofreading.
References Flentje, M., Eismann, H., Sieg, L., Friedrich, L., & Breuer, G. (2018). Simulation als Fortbildungsmethode zur Professionalisierung von
22 Teams. AINS - An€asthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 53(01), 20-33. https://doi.org/10.1055/s-0043-105261. Introducing INACSL Standards of Best Practice: Simulation SM Operations. (2017). Clinical Simulation in Nursing, 13(12), 680. https://doi. org/10.1016/j.ecns.2017.10.004. Kardong-Edgren, S., Lungstrom, N., & Bendel, R. (2009). VitalSimÒ versus SimManÒ: A comparison of BSN student test scores, knowledge retention, and satisfaction. Clinical Simulation in Nursing, 5(3), e105e111. https://doi.org/10.1016/j.ecns.2009.01.007. Mahling, M., M€unch, A., Castan, C., Schubert, P., Haffner, L., Griewatz, J., ., & Reutershan, J. (2015). Building an audio/videofeedback system for simulation training in medical education. Bio-Algorithms and Med-Systems, 11(2), 89-99. https://doi.org/10.1515/bams2015-0010. Mueller, B. U. (2014). Quality and safety in pediatric hematology/oncology. Pediatric Blood & Cancer, 61(6), 966-969. https://doi.org/10. 1002/pbc.24946. Pietsch, U., Ney, L., Kreuzer, O., Berner, A., & Lischke, V. (2017). Helicopter emergency medical service simulation training in the extreme: Simulation-based training in a mountain weather chamber. Air Medical Journal, 36(4), 193-194. https://doi.org/10.1016/j.amj. 2017.03.004. St.Pierre, M., & Breuer, G. (2018). In Pierre, M. St., & Breuer, G. (Eds.), Simulation in der Medizin (2nd ed.). Berlin, Heidelberg: Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-662-54566-9.
pp 18-22 Clinical Simulation in Nursing Volume 38