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More Is Not Always Better in Simulation. Learners' Evaluation of a "Chest Model".

ABSTRACT: Background: Fidelity in simulation is an important design feature. Although it is typically seen as bipolar (i.e., "high" or "low"), fidelity is actually multidimensional. There are concerns that "low fidelity" might impede the immersion of learners during simulation training. "Locally built models" are characterized by decreased cost and reduced "structural" fidelity (how the simulator looks) while satisfying "functional" fidelity (what the simulator does). Objective: To 1) describe the use of a locally built chest tube model in building a mastery-based simulation curriculum and 2) describe evaluation of the model from learners in different stages and contexts. Methods: The model was built on the basis of key functional features of the assigned training task. A curriculum that combined progressive difficulty and opportunities for deliberate practice and mastery was developed. An analysis of the learner's survey responses was performed using SAS studio (SAS Software). Results: We describe the process of creating the chest tube model and a curriculum in which the model is used for increasing levels of difficulty to reach skill mastery. Learners at different stages and in different contexts, such as practicing physicians and trainees from developed and developing countries, evaluated the model similarly. We provide validity evidence for the content, response process, and relationship with other variables when using the model in the assessment of chest tube insertion skills. Conclusion: As demonstrated in our chest tube critical care medicine curriculum, the locally built models are simple to build and feasible to use. Contrary to current thinking that low-fidelity models might impede immersion in simulation training for experienced learners, the survey results show that different learners provide very similar evaluations after practicing with the model.

SUBMITTER: Sao Pedro T

PROVIDER: S-EPMC8043267 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Animal-associated microbes are highly variable, contributing to a diverse set of symbiont-mediated phenotypes. Given that host and symbiont genotypes, and their interactions, can impact symbiont-based phenotypes across environments, there is potential for extensive variation in fitness outcomes. Pea aphids, Acyrthosiphon pisum, host a diverse assemblage of heritable facultative symbionts (HFS) with characterized roles in host defense. Protective phenotypes have been largely studied as single infections, but pea aphids often carry multiple HFS species, and particular combinations may be enriched or depleted compared to expectations based on chance. Here, we examined the consequences of single infection versus coinfection with two common HFS exhibiting variable enrichment, the antiparasitoid Hamiltonella defensa and the antipathogen Regiella insecticola, across three host genotypes and environments. As expected, single infections with either H. defensa or R. insecticola raised defenses against their respective targets. Single infections with protective H. defensa lowered aphid fitness in the absence of enemy challenge, while R. insecticola was comparatively benign. However, as a coinfection, R. insecticola ameliorated H. defensa infection costs. Coinfected aphids continued to receive antiparasitoid protection from H. defensa, but protection was weakened by R. insecticola in two clones. Notably, H. defensa eliminated survival benefits conferred after pathogen exposure by coinfecting R. insecticola Since pathogen sporulation was suppressed by R. insecticola in coinfected aphids, the poor performance likely stemmed from H. defensa-imposed costs rather than weakened defenses. Our results reveal a complex set of coinfection outcomes which may partially explain natural infection patterns and suggest that symbiont-based phenotypes may not be easily predicted based solely on infection status.IMPORTANCE The hyperdiverse arthropods often harbor maternally transmitted bacteria that protect against natural enemies. In many species, low-diversity communities of heritable symbionts are common, providing opportunities for cooperation and conflict among symbionts, which can impact the defensive services rendered. Using the pea aphid, a model for defensive symbiosis, we show that coinfections with two common defensive symbionts, the antipathogen Regiella and the antiparasite Hamiltonella, produce outcomes that are highly variable compared to single infections, which consistently protect against designated enemies. Compared to single infections, coinfections often reduced defensive services during enemy challenge yet improved aphid fitness in the absence of enemies. Thus, infection with multiple symbionts does not necessarily create generalist aphids with "Swiss army knife" defenses against numerous enemies. Instead, particular combinations of symbionts may be favored for a variety of reasons, including their abilities to lessen the costs of other defensive symbionts when enemies are not present.

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More Is Not Always Better in Simulation. Learners' Evaluation of a "Chest Model".

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