An interventional study of Unexpected death in Crisis Resource Management (CRM) Skills, Stress and Advanced Cardiovascular Life Support (ACLS) Skills, sponsored by Ottawa Hospital Research Institute. Completed at 2 sites in Canada. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2020-03-24.
Sponsored by Ottawa Hospital Research Institute · Not applicable, Interventional, and Health services research
Some educational researchers deliberately induce stress upon learners to in order to enhance retention; this practice is controversial and its utility must be weighed against the negative emotional effects it may have on participants. In this study we investigate the effect of the unexpected death of a simulation mannequin on the retention of non-technical and technical crisis resource management skills and consider the emotional impact of this acute stressor.
Background High-fidelity simulation is an increasingly used teaching tool that is proven to be effective for learning. According to the literature, by gradually increasing stress and emotions, more effective learning can be achieved. However, allowing the simulated patient to "die", as a deliberate stressor, is controversial. There is no previous research on the educational effect of letting a simulated patient die. We aim to evaluate the effects of simulated unexpected death on skill retention, stress levels, and emotions. We hypothesize that the occurrence of unexpected death will impact skill retention, and will be associated with higher stress levels and stronger emotions.
Methods After Institutional Research Ethics Board approval, 56 residents and fellows of different medical specialties will be randomized to either the intervention (unexpected death) or control (survive) group. Participants from both groups will have to individually manage a simulated cardiac arrest crisis. In the intervention group, the scenario will end by the death of the simulated patient, whilst in the control group the simulated patient will survive. Each participant will be immediately debriefed by a trained instructor. Three months later, skill retention will be assessed in a similar scenario. Crisis management performance of all scenarios will be rated by 2 blinded raters. Biological stress, cognitive appraisal, and emotions will be measured during both scenarios.
Implications The impact of simulated unexpected death on skill retention of residents and fellows will provide instructors with evidence to optimize scenario design and approach the role of stress and emotions in simulation-based education.
Exclusion Criteria:
The control group participants will complete a cardiac arrest simulation scenario on the first day in which the mannequin returns to spontaneous circulation at the end of the scenario. They will then complete a retention simulation session three months later.
The experimental group participants will complete a cardiac arrest simulation scenario on the first day in which the mannequin unexpectedly dies at the end of the scenario. They will then complete a retention simulation session three months later.
Other: Unexpected death
Non-technical Crisis Resource Management (CRM) skills
Assessed using the Ottawa Global Rating Scale
Time frame: 3 months
Technical CRM skills
Assessed using a checklist derived from the American Heart Association's Megacode Checklist
Time frame: 3 months
Salivary cortisol
Biomarker of stress
Time frame: 5 time points during each of the 2 simulation days
State-trait anxiety inventory
Self-perceived anxiety questionnaire
Time frame: 3 time points during each of the 2 simulation days
Cognitive appraisal
Ratio of perceived preparedness versus demands of a task
Time frame: 2 time points during each of the 2 simulation days
Positive and Negative Affect Schedule (PANAS)
Classification of emotions experienced
Time frame: 1 time point during each of the 2 simulation days
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Ottawa Hospital Research Institute