Traditional Poster Round
While there is a substantial body of literature on in-situ simulation, it focuses nearly exclusively on simulation outcomes rather than the most effective means to achieve desired goals. Although there is variation in the specific method of in-situ debriefing, strategies almost uniformly represent debriefing models used in the simulation center setting.1-5 With frequently differing objectives and time and space constraints, the use of traditional simulation center debriefing strategies warrants examination.6, 7
Deliberate practice has been shown repeatedly in Simulation Based Medical Education (SBME) to improve skill attainment.8 Rapid Cycle Deliberate Practice (RCDP) involves frequently interrupting the scenario to give feedback then “rewinding” and allowing learners the opportunity to correct errors. A systematic review of RCDP studies identified gaps in published data on RCDP use,9 including a lack of diversity in participants, and called for a broadening of participants beyond trainees to varied licensed practitioners. Our study participants reflect a true in-hospital response team at most academic medical centers. An additional area identified for further research was whether RCDP is superior to traditional methods of SBME.
The use of RCDP in First Five Minutes Training (FFM) decreases time to initiation of cardiopulmonary resuscitation (CPR) and improves team communication.
1. Compare time to initiation of critical actions between RCDP and traditional simulation
2. Determine the effect of RCDP on team communication
Proposed approach to addressing the hypothesis:
This is a prospective cohort study of interdisciplinary teams running from February 1, 2018-April 28, 2019. The study includes 3 phases: pre-intervention, intervention, and post-intervention, utilizing the same scenario throughout with only a change in patient presentation to limit response bias. The pre and post-intervention phases use our current in-situ training model for data collection. Sessions begin with 1-2 bedside nurses who escalate the situation as they deem appropriate, and receive a real-time response of providers and/or equipment. After the scenario, team members remain for a debriefing. During the intervention phase, participants were randomized to the control (traditional simulation) or intervention group (RCDP training). Both debriefing methods addressed FFM elements. During the post-intervention, teams participate in in-situ simulations identical to the pre-intervention model remaining in their initial intervention or control arms. Assessment methods consist of 2 tools, one measuring non-technical skills, the other measuring technical skills during the pre and post-intervention phases.
1. In situ cancellations due to patient census and acuity
2. Tracking and scheduling participants
Questions for discussion:
1. Additional streams for data analysis
2. Feasibility of multi-center collaboration