Transcript Pediatric Resuscitation Education

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.
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Introduction
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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.
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Study Objective
– To determine whether use of a script designed to facilitate debriefings
by novice instructors affects knowledge and team performance of
learners.
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Methods
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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).
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Setting
– 14 tertiary care centers across North America.
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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 12month-old infant in hypotensive shock progressing to ventricular
fibrillation.
– Debriefing script was designed to facilitate a 20-minute debriefing
session.
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Methods
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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.
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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.
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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
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Results
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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
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Comment
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Novice instructors of a standard PALS course benefit from use of a scripted
debriefing tool.
– Better cognitive outcomes.
– Better behavioral learning outcomes.
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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.
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Study supports the notion that debriefing is an integral element of the
simulated learning experience.
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Comment
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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.
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As yet untested: would standardized debriefing also help with more
experienced instructors?
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Contact Information
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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
([email protected]).
Funding/Support
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This study was funded by an educational research grant from the American Heart
Association.
Conflict of Interest Disclosures
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Several authors received research grants from the American Heart Association and
the Laerdal Foundation for Acute Medicine (please see article for details).
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