Gersten Jonker

Simulation at the frontier of the ZPD   85 4 APPENDIX 1. DESCRIPTION OF SIMULATION CONTEXT AND SCENARIOS Simulation overview Before enrolling in the multidisciplinary dedicated transitional year on acute care at the University Medical Center Utrecht, students take a formative multimodal pretest to focus on the elective entrustable professional activities that are the objectives of the year ahead. The junior residency-level test consists of 2 parts. The first part assesses knowledge with a written test, know-how with case-based discussions, and skills, with objective structured clinical examinations. The second part is an assessment of clinical performance in acute care that takes place in a simulated environment. Students take a similar posttest at the end of the year. This study focused on the second part of the pretest, i.e. the simulations. The simulation test has a total duration of 3 ½ hours for groups of 4 students, including introduction, familiarization, 12 individual tests (4 students in 3 scenarios), individual debriefing, waiting, breaks, and a group debrief and closure. With the description below we adhere to the guidelines for reporting simulation research by Cheng et al. [29]. Simulation environment The simulation pretest took place in the Simulation Center of Rijnstate Hospital, Velp, the Netherlands. The Center offers a secluded and quiet area for simulation consisting of a briefing room, a 54m 2 (581 ft 2 ) simulator room, a control roombehind a one-way screen, a debriefing room, and a waiting area. The simulator room mimics a room in a clinical environment and deploys a 2010 Laerdal Sim Man (Laerdal Benelux B.V., Amersfoort, the Netherlands). This high-fidelity manikin features a wide range of pulsations, heart sounds, and breath sounds and allows surgical interventions such as chest drains and a full range of airway management from bag-mask ventilation to cricothyroidotomy. The manikin is positioned in a hospital bed. No moulage is used on the manikin. Props are occasionally used, e.g. a bladder-flushing system in a post-TURP (trans-urethral resection of the prostate) hemorrhage scenario. A working 18G IV cannula is in situ in an antecubital vein. Themanikin can be connected to amonitor that can display pulse oximetry, noninvasive blood pressure, 3-lead electrocardiogram, capnography, and temperature. Further