Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing A Multicenter Randomized Trial

被引：130

作者：

Cheng, Adam ^{[1
]}

Hunt, Elizabeth A. ^{[2
,3
]}

Donoghue, Aaron ^{[4
,5
]}

Nelson-McMillan, Kristen ^{[2
,3
]}

Nishisaki, Akira ^{[5
]}

LeFlore, Judy ^{[6
]}

Eppich, Walter ^{[7
]}

Moyer, Mike ^{[8
]}

Brett-Fleegler, Marisa ^{[9
]}

Kleinman, Monica ^{[9
]}

Anderson, JoDee ^{[10
]}

Adler, Mark ^{[7
]}

Braga, Matthew ^{[11
]}

Kost, Susanne ^{[12
]}

Stryjewski, Glenn ^{[12
]}

Min, Steve ^{[13
]}

Podraza, John ^{[13
]}

Lopreiato, Joseph ^{[13
]}

Hamilton, Melinda Fiedor ^{[14
]}

Stone, Kimberly ^{[15
]}

Reid, Jennifer ^{[15
]}

Hopkins, Jeffrey ^{[16
]}

Manos, Jennifer ^{[17
]}

Duff, Jonathan ^{[18
]}

Richard, Matthew ^{[19
]}

Nadkarni, Vinay M. ^{[5
]}

机构：

[1] Univ Calgary, KidSim ASPIRE Res Program, Div Emergency Med, Alberta Childrens Hosp,Dept Pediat, Calgary, AB T3B 6A8, Canada

[2] Johns Hopkins Univ, Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21205 USA

[3] Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21205 USA

[4] Univ Penn, Childrens Hosp Philadelphia, Sch Med, Div Emergency Med, Philadelphia, PA 19104 USA

[5] Univ Penn, Childrens Hosp Philadelphia, Sch Med, Div Crit Care Med, Philadelphia, PA 19104 USA

[6] Univ Texas Arlington, Coll Nursing, Arlington, TX 76019 USA

[7] Northwestern Univ, Feinberg Sch Med, Ann & Robert H Lurie Childrens Hosp Chicago, Div Emergency Med, Chicago, IL 60611 USA

[8] Bethesda North Hosp, TriHlth Educ & Simulat Serv, Cincinnati, OH USA

[9] Harvard Univ, Childrens Hosp, Sch Med, Boston, MA 02115 USA

[10] Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Div Neonatol, Portland, OR 97201 USA

[11] Childrens Hosp Dartmouth, Div Crit Care Med, Hanover, NH USA

[12] Jefferson Med Coll, Nemours Alfred I duPont Hosp Children, Div Emergency Med, Wilmington, DE USA

[13] Uniformed Serv Univ Hlth Sci, Dept Pediat, Walter Reed Natl Mil Med Ctr, Bethesda, MD 20814 USA

[14] Childrens Hosp Pittsburgh, Div Crit Care Med, Pittsburgh, PA 15213 USA

[15] Univ Washington, Sch Med, Seattle Childrens Hosp, Div Emergency Med, Seattle, WA USA

[16] Childrens Med Ctr, Dept Pediat, Dallas, TX 75235 USA

[17] Cincinnati Childrens Med Ctr, Div Emergency Med, Cincinnati, OH USA

[18] Univ Alberta, Stollery Childrens Hosp, Div Crit Care Med, Edmonton, AB, Canada

[19] Dementia Guide Inc, Clinical, Halifax, NS, Canada

来源：

JAMA PEDIATRICS | 2013年 / 167卷 / 06期

关键词：

HIGH-FIDELITY SIMULATION; HUMAN PATIENT SIMULATOR; INTERNAL-MEDICINE RESIDENTS; CRITICAL-CARE PEDIATRICS; PERFORMANCE IMPROVEMENT; CARDIAC-ARREST; CARDIOPULMONARY ARRESTS; EMERGENCY-MEDICINE; TEAM PERFORMANCE; COGNITIVE AIDS;

D O I：

10.1001/jamapediatrics.2013.1389

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Importance: Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. Objective: To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. Design: Prospective, randomized, factorial study design. Setting: The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. Participants: We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. Intervention: Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. Main Outcomes and Measures: Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). Results: There was no significant difference at baseline in nonscripted vs scripted groups for MCQ(P=.87), BAT (P=.99), and CPT (P=.95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P=.04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16%[7.4%-28.5%] vs 8% [0.2%-31.6%]; P=.03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P=.18). Level of physical realism of the simulator had no independent effect on these outcomes. Conclusions and Relevance: The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.

引用

页码：528 / 536

页数：9

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