Transfer of learning and patient outcome in simulated crisis resource management : a systematic review

PURPOSE: Simulation-based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management (CRM). This systematic review was conducted to gain a better understanding of the impact of simulation-based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes. SOURCE: Studies on CRM, crisis management, crew resource management, teamwork, and simulation published up to September 2012 were searched in MEDLINE(®), EMBASE™, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC. All studies that used simulation-based CRM teaching with outcomes measured at Kirkpatrick Level 3 (transfer of learning to the workplace) or 4 (patient outcome) were included. Studies measuring only learners' reactions or simple learning (Kirkpatrick Level 1 or 2, respectively) were excluded. Two authors independently reviewed all identified titles and abstracts for eligibility. PRINCIPAL FINDINGS: Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation-based CRM learning into the clinical setting (Kirkpatrick Level 3). In three of these studies, simulation-enhanced CRM training was found significantly more effective than no intervention or didactic teaching. Five studies measured patient outcomes (Kirkpatrick Level 4). Only one of these studies found that simulation-based CRM training made a clearly significant impact on patient mortality. CONCLUSIONS: Based on a small number of studies, this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality

Le moment choisi pour faire des séances de rappel n’améliorerait pas la conservation des compétences acquises en réanimation par les professionnels de la santé : un essai contrôlé randomisé

Introduction: Booster sessions can improve cardiopulmonary resuscitation (CPR) skill retention among healthcare providers; however, the optimal timing of these sessions is unknown. This study aimed to explore differences in skill retention based on booster session timing. Methods: After ethics approval, healthcare providers who completed an initial CPR training course were randomly assigned to either an early booster, late booster, or no booster group. Participants’ mean resuscitation scores, time to initiate compressions, and time to successfully provide defibrillation were assessed immediately post-course and four months later using linear mixed models. Results: Seventy-three healthcare professionals were included in the analysis. There were no significant differences by randomization in the immediate post-test (9.7, 9.2, 8.9) or retention test (10.2, 9.8, and 9.5) resuscitation scores. No significant effects were observed for time to compression. Post-test time to defibrillation (mean ± SE: 112.8 ± 3.0 sec) was significantly faster compared to retention (mean ± SE: 120.4 ± 2.7 sec) (p = 0.04); however, the effect did not vary by randomization. Conclusion: No difference was observed in resuscitation skill retention between the early, late, and no booster groups. More research is needed to determine the aspects of a booster session beyond timing that contribute to skill retention.Introduction : Les séances de rappel peuvent favoriser la conservation des compétences en réanimation cardio-pulmonaire (RCP) chez les professionnels de la santé; toutefois, le moment optimal pour offrir ces séances est inconnu. Cette étude visait à explorer les différences dans la conservation de compétences en fonction du moment où intervient la séance de rappel. Méthodes : Après avoir obtenu une approbation éthique, nous avons réparti, au hasard, des professionnels de la santé ayant suivi une formation initiale en RCP entre un groupe de rappel précoce, un groupe de rappel tardif et un groupe qui ne reçoit pas de séance de rappel. Les scores moyens des participants pour la réussite de la réanimation, le temps moyen pris avant de commencer les compressions et le temps moyen pris pour effectuer avec succès la défibrillation ont été évalués immédiatement après la séance et quatre mois plus tard à l’aide de modèles mixtes linéaires. Résultats : Soixante-treize professionnels de la santé ont participé à l’étude. Il n’y a pas eu de différences significatives selon la randomisation dans les scores de réanimation du post-test immédiat (9,7; 9,2; 8,9) et du test sur la conservation des compétences (10,2; 9,8 et 9,5). Aucun effet significatif n’a été observé pour le délai avant d’entamer les compressions. Le délai pour la défibrillation était significativement plus court après la séance (moyenne ± SE : 112,8 ± 3,0 sec) que lors du test de conservation des compétences (moyenne ± SE : 120,4 ± 2,7 sec) (p=0,04); cependant, l’effet ne variait pas selon la randomisation. Conclusion : Aucune différence n’a été observée sur le plan de la conservation des compétences en réanimation entre les groupes de rappel précoce, de rappel tardif et d’absence de rappel. De plus amples recherches sont nécessaires pour déterminer les facteurs d’une séance de rappel, autres que le moment où elle intervient, qui contribueraient à la conservation des compétences

Facing hierarchy: a qualitative study of residents\u27 experiences in an obstetrical simulation scenario

BACKGROUND: Residents in surgical specialties face a steep hierarchy when managing medical crises. Hierarchy can negatively impact patient safety when team members are reluctant to speak up. Yet, simulation has scarcely been previously utilized to qualitatively explore the way residents in surgical specialities navigate this challenge. The study aimed to explore the experiences of residents in one surgical specialty, obstetrics and gynecology (Ob/Gyn), when challenging hierarchy, with the goal of informing future interventions to optimize resident learning and patient safety. METHODS: Eight 3rd- and 4th-year Ob/Gyn residents participated in a simulation scenario in which their supervising physician made an erroneous medical decision that jeopardized the wellbeing of the labouring mother and her foetus. Residents participated in 30-45 min semi-structured interviews that explored their approach to managing this scenario. Transcribed interviews were analysed using qualitative thematic inquiry by three research team members, finalizing the identified themes once consensus was reached. RESULTS: Study results show that the simulated scenario did create an experience of hierarchy that challenged residents. In response, residents adopted three distinct communication strategies while confronting hierarchy: (1) messaging - a mere reporting of existing clinical information; (2) interpretive - a deliberate construction of clinical facts aimed at swaying supervising physician\u27s clinical decision; and (3) advocative - a readiness to confront the staff physician\u27s clinical decision. Furthermore, residents utilized coping mechanisms to mitigate challenges related to confronting hierarchy, namely deflecting responsibility, diminishing urgency, and drafting allies. Both these communication strategies and coping mechanisms shaped their practice when challenging hierarchy to preserve patient safety. CONCLUSIONS: Understanding the complex processes in which residents engage when confronting hierarchy can serve to inform the development and study of curricular innovations. Informed by these processes, we must move beyond solely teaching residents to speak up and consider a broader curriculum that targets not only residents but also faculty physicians and the learning environment within the organization

Barriers and facilitators to implementing a regional anesthesia service in a low-income country: a qualitative study

Introduction: regional anesthesia is a safe alternative to general anesthesia. Despite benefits for perioperative morbidity and mortality, this technique is underutilized in low-resource settings. In response to an identified need, a regional anesthesia service was established at the University Teaching Hospital of Kigali (CHUK), Rwanda. This qualitative study investigates the factors influencing implementation of this service in a low-resource tertiary-level teaching hospital. Methods: following service establishment, we recruited 18 local staff at CHUK for in-depth interviews informed by the “Consolidated Framework for Implementation Research” (CFIR). Data were coded using an inductive approach to discover emergent themes. Results: four themes emerged during data analysis. Patient experience and outcomes: where equipment failure is frequent and medications unavailable, regional anesthesia offered clear advantages including avoidance of airway intervention, improved analgesia and recovery and cost-effective care. Professional satisfaction: morale among healthcare providers suffers when outcomes are poor. Participants were motivated to learn techniques that they believe improve patient care. Human and material shortages: clinical services are challenged by high workload and human resource shortages. Advocacy is required to solve procurement issues for regional anesthesia equipment. Local engagement for sustainability: participants emphasized the need for a locally run, sustainable service. This requires broad engagement through education of staff and long-term strategic planning to expand regional anesthesia in Rwanda. Conclusion: while the establishment of regional anesthesia in Rwanda is challenged by human and resource shortages, collaboration with local stakeholders in an academic institution is pivotal to sustainability

Transfer of learning and patient outcome in simulated crisis resource management: a systematic review

PURPOSE: Simulation-based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management (CRM). This systematic review was conducted to gain a better understanding of the impact of simulation-based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes. SOURCE: Studies on CRM, crisis management, crew resource management, teamwork, and simulation published up to September 2012 were searched in MEDLINE(®), EMBASE™, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC. All studies that used simulation-based CRM teaching with outcomes measured at Kirkpatrick Level 3 (transfer of learning to the workplace) or 4 (patient outcome) were included. Studies measuring only learners’ reactions or simple learning (Kirkpatrick Level 1 or 2, respectively) were excluded. Two authors independently reviewed all identified titles and abstracts for eligibility. PRINCIPAL FINDINGS: Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation-based CRM learning into the clinical setting (Kirkpatrick Level 3). In three of these studies, simulation-enhanced CRM training was found significantly more effective than no intervention or didactic teaching. Five studies measured patient outcomes (Kirkpatrick Level 4). Only one of these studies found that simulation-based CRM training made a clearly significant impact on patient mortality. CONCLUSIONS: Based on a small number of studies, this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12630-014-0143-8) contains supplementary material, which is available to authorized users

Anesthesia Provider Training and Practice Models: A Survey of Africa.

BACKGROUND:In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically underresourced countries. METHODS:Between 2016 and 2018, we conducted electronic, phone, and in-person surveys of anesthesia providers in Africa. The surveys focused on the presence of anesthesia training programs, training program characteristics, and clinical scope of practice after graduation. RESULTS:One hundred thirty-one respondents completed surveys representing data for 51 of 55 countries in Africa. Most countries had both PA and NPAP training programs (57%; mean, 1.6 pathways per country). Thirty distinct training pathways to become an anesthesia provider could be discriminated on the basis of entry qualification, duration, and qualification gained. Of these 30 distinct pathways, 22 (73%) were for NPAPs. Physician and NPAP program durations were a median of 48 and 24 months (ranges: 36-72, 9-48), respectively. Sixty percent of NPAP pathways required a nursing background for entry, and 60% conferred a technical (eg, diploma/license) qualification after training. Physicians and NPAPs were trained to perform most anesthesia tasks independently, though few had subspecialty training (such as regional or cardiac anesthesia). CONCLUSIONS:Despite profound anesthesia provider shortages throughout Africa, most countries have both NPAP and PA training programs. NPAP training pathways, in particular, show significant heterogeneity despite relatively similar scopes of clinical practice for NPAPs after graduation. Such heterogeneity may reflect the varied needs and resources for different settings, though may also suggest lack of consensus on how to train the anesthesia workforce. Lack of consistent terminology to describe the anesthesia workforce is a significant challenge that must be addressed to accelerate workforce research and planning efforts

The h-index in medical education: an analysis of medical education journal editorial boards

Abstract Background: Disciplines differ in their authorship and citation practices, thus discipline-specific h-index norms are desirable. Thus the goal of this study was to examine the relationship between the h-index and academic rank in the field of medical education, and the differences in the h-index between MD’s and PhD’s in this field. Methods: Due to the absence of a formalized registry of medical educators, we sampled available editorial board membership (considered a proxy for identifying ‘career’ medical educators) to establish h-index values. These were determined using Web of Science (WoS) and Google Scholar (GS), and internet searching was used to determine their academic rank. The correlation between authors’ h-indices derived from WoS and GS was also determined. Results: 130 editors were identified (95 full professors, 21 associate professors, 14 assistant professors). A significant difference was noted between the h-indices of full professors and associate/assistant professors (p < .001). Median h-indices equaled 14 for full professors (Interquartile range [IQR] =11); 7 for associate professors (IQR =7) and 6.5 for assistant professors (IQR = 8). h-indices of MD’s and PhD’s did not differ significantly. Moderate correlation between GS and WOS h-indices was noted R = 0.46, p < .001. Conclusions: The results provide some guidance as to the expected h-indices of a select group of medical educators. No differences appear to exist between assistant professor and associate professor ranks or between MD’s and PhD’s