examining pediatric resuscitation education using simulation and scripted debriefing

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JAMA Pediatrics Journal Club Slides:Pediatric Resuscitation Education

Cheng A, Hunt EA, Donoghue A, et al; EXPRESS Investigators. Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial. JAMA Pediatr. Published online April 22, 2013. doi:10.1001/jamapediatrics.2013.1389.


• Background– Simulation is a common educational modality in resuscitation training

programs, such as Pediatric Advanced Life Support (PALS).– Debriefing following simulated or real resuscitations can improve the

process and outcome of resuscitations.– The most effective manner in which to train novice instructors to debrief

has not been established.– Use of a debriefing cognitive aid for simulation-based education has not

been explored.

• Study Objective– To determine whether use of a script designed to facilitate debriefings

by novice instructors affects knowledge and team performance of learners.

Introduction


• Study Design– Multicenter, prospective, randomized, blinded, factorial design.– Randomized to 1 of 4 different combinations of debriefing type (scripted,

nonscripted) and physical realism simulator (low, high).

• Setting– 14 tertiary care centers across North America.

• Participants– Novice instructors were recruited to debrief resuscitation simulations.– Resuscitation teams had 4 or 5 participants and were interprofessional.– Simulation scenario: standardized 12-minute scenario, depicting 12-

month-old infant in hypotensive shock progressing to ventricular fibrillation.

– Debriefing script was designed to facilitate a 20-minute debriefing session.

Methods


Methods

• Outcomes– Multiple-choice test to assess medical knowledge of individual

participants.– Clinical Performance Tool to assess clinical management of the team.– Behavioral Assessment Tool to assess team leader’s behavioral

performance.– 16 video reviewers rated videos of debriefing sessions.

• Limitations – Study limited to 1 type of scenario.– Debriefing script was provided, but without instructions (to ensure practical

application and widespread implementation).– Mode of questioning used in the script was not as open-ended as in

traditional reflective debriefing.


Results• Study Population

– 453 participants, composing 104 teams

– July 2008 to February 2011

Comparison of Demographic Characteristics

Between the 4 Study Arms for All 443 Participants


Results• Participants receiving scripted debriefing showed greater improvement compared with participants

randomized to nonscripted debriefing.• Team leaders receiving scripted debriefing showed greater improvement in Behavioral Assessment

Tool scores compared with those receiving nonscripted debriefing.• There was no significant difference in the team clinical performance related to scripted debriefing.

Postintervention vs Preintervention Comparison Scores

for MCQ, BAT, and CPT


Comment

• Novice instructors of a standard PALS course benefit from use of a scripted debriefing tool.

– Better cognitive outcomes.

– Better behavioral learning outcomes.

• No significant improvement in clinical performance score of the teams.

– May be related to team dynamic (dependent on multiple factors, not just debriefing) and 1 scenario.

• Study supports the notion that debriefing is an integral element of the simulated learning experience.


Comment

• The American Heart Association has incorporated a new debriefing tool into the 2011 PALS instructor manuals and courses.

– Signals a shift in philosophy regarding instructor training and standardization of the team learning process.

• As yet untested: would standardized debriefing also help with more experienced instructors?


• If you have questions, please contact the corresponding author:– Adam Cheng, MD, University of Calgary, KidSim-ASPIRE, Research Program, Division

of Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada ([email protected]).

Funding/Support

• This study was funded by an educational research grant from the American Heart Association.

Conflict of Interest Disclosures

• Several authors received research grants from the American Heart Association and the Laerdal Foundation for Acute Medicine (please see article for details).

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examining pediatric resuscitation education using simulation and scripted debriefing

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