Conducting multicenter research in healthcare simulation: Lessons learned from the INSPIRE network

Abstract

Simulation-based research has grown substantially over the past two decades; however, relatively few published simulation studies are multicenter in nature. Multicenter research confers many distinct advantages over single-center studies, including larger sample sizes for more generalizable findings, sharing resources amongst collaborative sites, and promoting networking. Well-executed multicenter studies are more likely to improve provider performance and/or have a positive impact on patient outcomes. In this manuscript, we offer a step-by-step guide to conducting multicenter, simulation-based research based upon our collective experience with the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE). Like multicenter clinical research, simulation-based multicenter research can be divided into four distinct phases. Each phase has specific differences when applied to simulation research: (1) Planning phase, to define the research question, systematically review the literature, identify outcome measures, and conduct pilot studies to ensure feasibility and estimate power; (2) Project Development phase, when the primary investigator identifies collaborators, develops the protocol and research operations manual, prepares grant applications, obtains ethical approval and executes subsite contracts, registers the study in a clinical trial registry, forms a manuscript oversight committee, and conducts feasibility testing and data validation at each site; (3) Study Execution phase, involving recruitment and enrollment of subjects, clear communication and decision-making, quality assurance measures and data abstraction, validation, and analysis; and (4) Dissemination phase, where the research team shares results via conference presentations, publications, traditional media, social media, and implements strategies for translating results to practice. With this manuscript, we provide a guide to conducting quantitative multicenter research with a focus on simulation-specific issues.Electronic supplementary materialThe online version of this article (doi:10.1186/s41077-017-0039-0) contains supplementary material, which is available to authorized users.

Using clinical simulation to study how to improve quality and safety in healthcare

“…Cheng et al provide a guide for multicentre simulation studies,41 which offer several advantages. The ability to standardise the simulation across participating sites helps to isolate independent variables and to reduce the risk of bias introduced by variations in local contexts 41.…”

How to include medical students in your healthcare simulation centre workforce

“…The confederate role is often played by a health care professional, but students can also function as confederates, to provide patient history and participate in a handover situation and support the learners by providing information or create distractions or conflicts during scenarios. Confederates can also be used to standardize the setting and provide the much-needed case-to-case consistency in simulation research [6,8].…”

Barriers and Solutions to Advancing Emergency Medicine Simulation–based Research: A Call to Action

“…For simulationists trained primarily as educators but are interested in entering the research arena, collaboratives can provide easy entry for learning research methodologies and building the skills and publications necessary for developing their own research career and initial grant applications. Existing recommendations on logistics, operational framework, site selection, leadership, subcommittees, guidelines for authorship, and measures for success can be extrapolated from established collaboratives like INSPIRE and expert consensus work on an EM education research network during the 2012 Academic Emergency Medicine consensus conference Position #2: Development of an EM‐based simulation research collaborative will facilitate higher scientific quality and productivity, including multicenter studies and reporting of patient‐level outcomes .Recommended Action Item #2a: Establish an EM simulation research collaborative.…”

“…The pediatric simulation community created the International Network for Simulation‐based Pediatric Innovation, Research, and Education (INSPIRE) to address this issue, which uses a crowd‐sourcing, collaborative approach to assist simulation‐based investigators in improving their scientific and methodologic rigor. This initiative has resulted in multiple successful collaborations and publications, ranging from pediatric resuscitation to procedural skills …”