Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing A Multicenter Randomized Trial Pediatric Resuscitation Education

Cheng A, Hunt EA, Donoghue A, et al. — Mon, 22 Apr 2013 00:00:00 GMT

Importance

Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings.

Objective

To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests.

Design

Prospective, randomized, factorial study design.

Setting

The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing.

Participants

We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups.

Intervention

Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators.

Main Outcomes and Measures

Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC).

Results

There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes.

Conclusions and Relevance

The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.

Deconstructing Debriefing for Simulation-Based Education Debriefing for Simulation-Based Education

Edelson DP, LaFond CM. — Mon, 22 Apr 2013 00:00:00 GMT

Simulation-based education has become increasingly popular in medicine, especially for rare, complex, and high-risk events such as cardiac resuscitations. Championed by the patient safety movement and supported by technological advances in patient simulators, it is difficult to find training programs today that do not use the technique in some form. However, the implementation of simulation often varies so widely, both across and within institutions, that the findings are difficult to generalize and variables, such as the level of realism, experience of the instructor, and content of the debriefing, are often insufficiently described to replicate. That was not the case with the Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) trial, an ambitious multicenter, randomized study, the results of which are published in this issue of JAMA Pediatrics. In it, the investigators developed a debriefing script for leading Pediatric Advanced Life Support instructors through a postsimulation debrief, covering both medical management and team dynamics, and demonstrated that its use, in the hands of novice instructors, was associated with greater improvements in knowledge and subsequent team leader performance. In addition, the trial demonstrated no benefit to high realism simulator technology. This study affirms the relative importance of debriefing in simulation-based education and establishes a roadmap for generalized dissemination of the technique in a reproducible format.

JAMA Pediatrics: Cardiac Arrest/Resuscitation Topic Collection

Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing A Multicenter Randomized Trial Pediatric Resuscitation Education

Deconstructing Debriefing for Simulation-Based Education Debriefing for Simulation-Based Education