title: Mobile in Situ Simulation as a Tool for Evaluation and Improvement of Trauma Treatment in the Emergency Department.
abstract: BACKGROUND
  Medical simulation is an increasingly recognized tool for teaching, coaching, training, and examining practitioners in the medical field. For many years, simulation has been used to improve trauma care and teamwork. Despite technological advances in trauma simulators, including better means of mobilization and control, most reported simulation-based trauma training has been conducted inside simulation centers, and the practice of mobile simulation in hospitals' trauma rooms has not been investigated fully.
  
  
  METHODS
  The emergency department personnel from a second-level trauma center in Israel were evaluated. Divided into randomly formed trauma teams, they were reviewed twice using in situ mobile simulation training at the hospital's trauma bay. In all, 4 simulations were held before and 4 simulations were held after a structured learning intervention. The intervention included a 1-day simulation-based training conducted at the Israel Center for Medical Simulation (MSR), which included video-based debriefing facilitated by the hospital's 4 trauma team leaders who completed a 2-day simulation-based instructors' course before the start of the study. The instructors were also trained on performance rating and thus were responsible for the assessment of their respective teams in real time as well as through reviewing of the recorded videos; thus enabling a comparison of the performances in the mobile simulation exercise before and after the educational intervention.
  
  
  RESULTS
  The internal reliability of the experts' evaluation calculated in the Cronbach α model was found to be 0.786. Statistically significant improvement was observed in 4 of 10 parameters, among which were teamwork (29.64%) and communication (24.48%) (p = 0.00005).
  
  
  CONCLUSIONS
  The mobile in situ simulation-based training demonstrated efficacy both as an assessment tool for trauma teams' function and an educational intervention when coupled with in vitro simulation-based training, resulting in a significant improvement of the teams' function in various aspects of treatment.
authors.affiliation: The Israel Center for Medical Simulation (MSR), Sheba Medical Center, Tel Hashomer, Israel; Department of Surgery, Sheba Medical Center, Tel Hashomer, Israel. Electronic address: imri.amiel@sheba.health.gov.il.
authors.forename: Imri
authors.initials: I
authors.lastname: Amiel
authors.affiliation: Trauma Unit, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Simon
authors.affiliation: Trauma Unit, Department of Cardiothoracic Surgery, Shaarei-Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Merin
authors.affiliation: The Israel Center for Medical Simulation (MSR), Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amitai
authors.initials: A
authors.lastname: Ziv
mesh_terms: D002983:Clinical Competence; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000592:standards*; D008348:Manikins; D058996:Quality Improvement; D000066908:Simulation Training; D014194:Traumatology / Q000193:education*
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; Professionalism; high-fidelity patient simulators; in situ simulation; mobile simulation