alert 2014-new-flannery

ALERT Presentation: The effect of resident fatigue on

simulation training outcomes

Ashley L. Flannery, DO, Neeraja Kairam, MD, Hetal Patel,

MD,

David Salo, MD, PhD

Morristown Medical Center

INSPIRE @ IMSH 2014: San Francisco, California,USAInternational Network for Simulation-based Pediatric Innovation, Research and Education

• 2012 NEJM report examined resident

physician duty hour restrictions

• However there is a lack of evidence to

support these claims

International Network for Simulation-based Pediatric Innovation, Research and Education

Background

• What we do know:

– Simulation is an effective tool in assessing

the knowledge and skills of resident

physicians


Background

• P: Emergency Medicine (EM) residents

• I: Fatigue

• C: pre day shift and post night shift (12 hours)

• O: number of critical outcomes achieved


PICO Question

• Sample of 16 EM residents, PGY1-3

– One simulation at start of 12 hour day shift

– One simulation at conclusion of 12 hour night shift

– Washout period of 12 weeks between simulations


Approach / Design

• Simulation scenario: pediatric septic shock

– Two cases with altered HPIs

– Same critical actions to be performed.

• Assessment

– Performance assessment tool

• measure completion of clinically appropriate interventions

– Record duration of time to complete tasks


Approach / Design

• Subjects will be analyzed

– Paired statistical testing

– Cross-over model

• half of the subjects starting the protocol under

increased fatigue (post night shift)

• half of the subjects in a non-fatigue situation (day

shift)


Approach / Design

• IRB approval received- October 2013

• ALERT Presentation- January 2014

• Recruitment / Data Collection- January and April 2014

• Data Analysis

• Abstract Presentation

• Manuscript Preparation


Timeline

1. Is the number of residents sufficient to see a true

difference?

2. We are using the same case twice with slight

variations in the HPI. Even with the washout period, it

may lead to improved scores on second simulation. Is

there a way to control for that?

3. Will this study be able to be used as a stepping point

to determine if 8 hr vs 12 hr shifts are better or to limit

consecutive shifts?


3 Questions to improve study

Ashley Flannery [email protected]

Neeraja Kairam [email protected]

Morristown Medical Center

Morristown, NJ


Contact Information