Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing

Article link available at: http://archpedi.jamanetwork.com/article.aspx?articleid=1678598
Powerpoint slides available at:
http://archpedi.jamanetwork.com/data/Journals/PEDS/927055/POA120099slidea_prod.ppt

1. Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Pediatric Resuscitation Education Cheng A, Hunt EA, Donoghue A, et al; EXPRESS Investigators. Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial. JAMA Pediatr. Published online April 22, 2013. doi:10.1001/jamapediatrics. 2013.1389.
2. Copyright restrictions may apply •  Background –  Simulation is a common educational modality in resuscitation training programs, such as Pediatric Advanced Life Support (PALS). –  Debriefing following simulated or real resuscitations can improve the process and outcome of resuscitations. –  The most effective manner in which to train novice instructors to debrief has not been established. –  Use of a debriefing cognitive aid for simulation-based education has not been explored. •  Study Objective –  To determine whether use of a script designed to facilitate debriefings by novice instructors affects knowledge and team performance of learners. Introduction
3. Copyright restrictions may apply •  Study Design –  Multicenter, prospective, randomized, blinded, factorial design. –  Randomized to 1 of 4 different combinations of debriefing type (scripted, nonscripted) and physical realism simulator (low, high). •  Setting –  14 tertiary care centers across North America. •  Participants –  Novice instructors were recruited to debrief resuscitation simulations. –  Resuscitation teams had 4 or 5 participants and were interprofessional. –  Simulation scenario: standardized 12-minute scenario, depicting 12- month-old infant in hypotensive shock progressing to ventricular fibrillation. –  Debriefing script was designed to facilitate a 20-minute debriefing session. Methods
4. Copyright restrictions may apply Methods •  Outcomes –  Multiple-choice test to assess medical knowledge of individual participants. –  Clinical Performance Tool to assess clinical management of the team. –  Behavioral Assessment Tool to assess team leader’s behavioral performance. –  16 video reviewers rated videos of debriefing sessions. •  Limitations –  Study limited to 1 type of scenario. –  Debriefing script was provided, but without instructions (to ensure practical application and widespread implementation). –  Mode of questioning used in the script was not as open-ended as in traditional reflective debriefing.
5. Copyright restrictions may apply Results •  Study Population –  453 participants, composing 104 teams –  July 2008 to February 2011 Comparison of Demographic Characteristics Between the 4 Study Arms for All 443 Participants
6. Copyright restrictions may apply Results •  Participants receiving scripted debriefing showed greater improvement compared with participants randomized to nonscripted debriefing. •  Team leaders receiving scripted debriefing showed greater improvement in Behavioral Assessment Tool scores compared with those receiving nonscripted debriefing. •  There was no significant difference in the team clinical performance related to scripted debriefing. Postintervention vs Preintervention Comparison Scores for MCQ, BAT, and CPT
7. Copyright restrictions may apply Comment •  Novice instructors of a standard PALS course benefit from use of a scripted debriefing tool. –  Better cognitive outcomes. –  Better behavioral learning outcomes. •  No significant improvement in clinical performance score of the teams. –  May be related to team dynamic (dependent on multiple factors, not just debriefing) and 1 scenario. •  Study supports the notion that debriefing is an integral element of the simulated learning experience.
8. Copyright restrictions may apply Comment •  The American Heart Association has incorporated a new debriefing tool into the 2011 PALS instructor manuals and courses. –  Signals a shift in philosophy regarding instructor training and standardization of the team learning process. •  As yet untested: would standardized debriefing also help with more experienced instructors?
9. Copyright restrictions may apply •  If you have questions, please contact the corresponding author: –  Adam Cheng, MD, University of Calgary, KidSim-ASPIRE, Research Program, Division of Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada (adam.cheng@albertahealthservices.ca). Funding/Support •  This study was funded by an educational research grant from the American Heart Association. Conflict of Interest Disclosures •  Several authors received research grants from the American Heart Association and the Laerdal Foundation for Acute Medicine (please see article for details). Contact Information