Is it valid to assess an individual’s performance in team training simulation when the supporting team are confederates? A controlled and randomized clinical trial

Abstract

Background During simulation training, the confederate is a member of the pedagogical team. Its role is to facilitate the interaction between participants and the environment, and is thought to increase realism and immersion. Its influence on participants' performance in full-scale simulation remains however unknown. The purpose of this study was to observe the effect of the presence of confederates on the participants’ performance during full-scale simulation of crisis medical situations. Methods This was a prospective, randomized study comparing 2 parallel groups. Participants were emergency medicine residents engaging in a simulation session, with or without confederates. Participants were then evaluated on their Crisis Resource Management performance (CRM). The overall performance score on the Ottawa Global Rating Scale was assessed as primary outcome and the 5 non-technical CRM skills as secondary outcomes. Results A total of 63 simulation sessions, including 63 residents, were included for statistical analysis (n = 32 for Control group and 31 for Confederate group). The mean Overall Performance score was 3.9 ± 0.8 in the Control group and 4.0 ± 1.1 in the Confederate group, 95% confidence interval of the difference [-0.6; 0.4], p = 0.60. No significant differences between the two groups were observed on each CRM items (leadership, situational awareness, communication, problem solving, resource utilization) Conclusion In this randomized and controlled study, the presence of confederates during full-scale simulated practice of crisis medical situations does not seem to influence the CRM skills performance of Emergency medicine residents. Trial registration This study does not need to be registered on Clintrial as it does not report a health care intervention on human participants.

Comparing Leadership Skills of Senior Emergency Medicine Residents in 3-Year Versus 4-Year Programs During Simulated Pediatric Resuscitation

“…Does simulation performance correlate to clinical performance? However, some recent literature suggests that simulation performance may correlate well with actual clinical performance 53,54 …”

“…However, some recent literature suggests that simulation performance may correlate well with actual clinical performance. 53,54…”

Influence of the embedded participant on learners’ performance during high-fidelity simulation sessions in healthcare

“…Therefore, we may suggest that the performance of learners is affected not only by demographic factors such as age, gender, or experience, but also by other factors such as emotional intelligence, personality of the EP, gender mix and human interactions between both the learner and the EP [ 18 ]. Among the few studies focusing on the EP, one explored the effect of the presence of an EP on participants’ non-technical performance during simulated practice of medical crisis situations [ 19 ]. In contrast to our results, a previous study conducted by Traoré et al reported that the presence of EPs during simulation scenarios did not seem to improve the crisis resource management skills of learners [ 19 ].…”

“…Among the few studies focusing on the EP, one explored the effect of the presence of an EP on participants’ non-technical performance during simulated practice of medical crisis situations [ 19 ]. In contrast to our results, a previous study conducted by Traoré et al reported that the presence of EPs during simulation scenarios did not seem to improve the crisis resource management skills of learners [ 19 ]. They presented a non-significant difference when comparing overall crisis resource management performance between learners who were accompanied by an EP and those who were not.…”

Usability Testing Via Simulation

“…However, some recent literature suggests that simulation performance may correlate well with actual clinical performance. 29,30 We acknowledge that participants were informed the simulated cases involved respiratory failure necessitating intubation, which may have altered participant performance. We also allowed each team member to have a copy of the checklist during the scenarios, which is likely different from how the checklist might be used in the clinical setting.…”