Oral Themed Presentation
Oral Themed
David Greaney, MSc FRCA FJFICMI
Clinical Fellow
Hospital for Sick Children
Danelle Dower, MD
Clinical Fellow
Hospital for Sick Children
Elaine Ng, MD, FRCPC, MSHPEd
Anesthesiologist
Hospital for Sick Children
Tobias Everett, MD
Anesthesiologist
Hospital for Sick Children
Background: : The novel simulation delivery technique of rapid cycle deliberate practice (RCDP) combines the features of within-simulation directed feedback with skill repetition to achieve two key components of simulation based medical education (SBME): mastery learning from directed feedback and repetitive practice1,2. This “pause, analyse, rewind, repeat” technique may promote greater knowledge transfer, skill retention, and learner acceptability compared to traditional SBME (where debriefing occurs after the conclusion of the simulation), although the simulation literature is conflicting regarding optimal timing of debriefing2-8.
Research Question: : Hypothesis:
• Primary: RCDP improves participants’ overall performance when rated by blinded expert assessors and improves key time-to-event outcomes
• Secondary: RCDP is preferred by participants to traditional SMBE
Methodology: : We describe our randomized, controlled, single-blinded, single-centre superiority trial with two parallel groups. Following REB approval, pediatric anesthesiology residents and fellows who consented were randomised to RCDP vs traditional end-of-scenario debriefing and engaged in an operating room crisis scenario using one of those techniques. Participants then engaged in a test scenario. Filmed performances were evaluated by expert raters using global rating scale for which we have previously published validity evidence. Raters were trained rigorously until their interrater reliability as measured with the intraclass correlation coefficient was >0.8. Time-to-event data was also collected regarding interval between certain triggers and recognition or intervention by the participant. We collected data from the participants regarding their reactions and perceptions of the teaching interventions. These data were from Likert scales and were analysed with Mann-Whitney tests for unmatched pairs.
Results: : 39 candidates were recruited, 20 to RCDP, 19 to traditional post-simulation debriefing. There was no difference in participants’ perception of acceptability or impact between the two simulation modes. As an example, when asked to self-assess if the simulation had conferred an increase in ability to manage the real-life scenario, 44% strongly agreed and 56% agreed in the RCDP group whereas 53% strongly agreed, 40% agreed and 7% were neutral in the traditional group (p=0.75). Video rating is on-going at time of abstract submission, with complete results to be available at time of IMSH2019.
Discussion/Conclusions: : We did not find data to support participant preference of RCDP over traditional SBME. Qualitative data in this regard suggested that the increased complexity of anesthesia crisis scenarios over algorithm-based crises (e.g. ACLS) dictates that the situation needs to evolve and develop and consequently does not benefit from frequent interruptions. We suggest that RCDP be reserved for scenarios where there is a well-established timeline, deviations from which are overt and in definite need of correction. At time of IPSSW 2019 we will be able to describe the differential effect on participant performance. In a follow-up investigation we will establish in a retention test if one modality results in superior knowledge retention and transferability.