Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice

Goldberg, Andrew; Silverman, Eric; Samuelson, Stefan T.; Katz, Daniel; Lin, Hung‐Mo; Levine, Adam I.; DeMaría, Samuel

doi:10.1093/bja/aeu457

Cited by 25 publications

(14 citation statements)

References 27 publications

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“…This may be explained by the workload experienced in the scenario we employed,10 though previous studies illustrate participants in pipeline contamination scenarios generally exhibit low levels of competency irrespective of added workload 24 25 49 50. While oxygen pipeline contamination is rare, gas delivery equipment is still a source of anaesthesia claims51 and thorough reviews of the workstation periodically are an important facet of continuing education.…”

Section: Discussionmentioning

confidence: 98%

Performance gaps and improvement plans from a 5-hospital simulation programme for anaesthesiology providers: a retrospective study

et al. 2017

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BackgroundSimulation is increasingly employed in healthcare provider education, but usage as a means of identifying system-wide practitioner gaps has been limited. We sought to determine whether practice gaps could be identified, and if meaningful improvement plans could result from a simulation course for anaesthesiology providers.MethodsOver a 2-year cycle, 288 anaesthesiologists and 67 certified registered nurse anaesthetists (CRNAs) participated in a 3.5 hour, malpractice insurer-mandated simulation course, encountering 4 scenarios. 5 anaesthesiology departments within 3 urban academic healthcare systems were represented. A real-time rater scored each individual on 12 critical performance items (CPIs) representing learning objectives for a given scenario. Participants completed a course satisfaction survey, a 1-month postcourse practice improvement plan (PIP) and a 6-month follow-up survey.ResultsAll recorded course data were retrospectively reviewed. Course satisfaction was generally positive (88–97% positive rating by item). 4231 individual CPIs were recorded (of a possible 4260 rateable), with a majority of participants demonstrating remediable gaps in medical/technical and non-technical skills (97% of groups had at least one instance of a remediable gap in communication/non-technical skills during at least one of the scenarios). 6 months following the course, 91% of respondents reported successfully implementing 1 or more of their PIPs. Improvements in equipment/environmental resources or personal knowledge domains were most often successful, and several individual reports demonstrated a positive impact on actual practice.ConclusionsThis professional liability insurer-initiated simulation course for 5 anaesthesiology departments was feasible to deliver and well received. Practice gaps were identified during the course and remediation of gaps, and/or application of new knowledge, skills and resources was reported by participants.

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Section: Discussionmentioning

confidence: 98%

Performance gaps and improvement plans from a 5-hospital simulation programme for anaesthesiology providers: a retrospective study

et al. 2017

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“…2,23e26 We have shown improved retention of knowledge with simulations where students are allowed to fail and cause simulated mortality, but we did not evaluate each parameter individually. 20 Proponents of allowing simulated mortality believe in the benefit of using simulated death as a teaching tool, 14e19 whilst opponents of simulated mortality believe it places undue stress on the learner. 11e13 No studies have evaluated the effect of independence with or without simulated mortality, or if one combination is better in improving knowledge retention.…”

Section: Discussionmentioning

confidence: 99%

“…without senior intervention) leading to simulated mortality during a simulated oxygen pipeline contamination, improved knowledge retention, performance, and scenario memorability at follow-up 6 months later. 20 It was unclear if this effect was caused by the independent practice or the simulated mortality itself.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Knowledge retention after simulated crisis: importance of independent practice and simulated mortality

Burnett

Goldberg

DeMaría

et al. 2019

British Journal of Anaesthesia

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Background: Simulation is an important component of postgraduate medical education, but optimal parameters for simulation are not known. Managing simulations independently and allowing simulated morbidity and mortality have been shown to improve follow-up performance in simulation. We hypothesised that allowing simulated mortality improves performance in follow-up simulations more than independent practice. Methods: Using a randomised, controlled, observer-blinded design, 48 first-year residents in anaesthesia were exposed to a hyperkalaemia scenario. Subjects were divided into two groups (n¼24) that allowed for independent practice or support from an attending physician. Each of these groups was then subdivided into two groups (n¼12) that allowed for simulated mortality or did not. All groups received a standardised debriefing. Six months later, the subjects returned to manage a different hyperkalaemia scenario independently with potential simulated mortality. The primary outcome was total treatment score; secondary outcomes included subjects' time to request diagnostic information, time to treatment, and simulator mortality rate. Results: Subject characteristics were not statistically different. The independent practiceemortality possible group had the highest total treatment score (P¼0.004), fastest time to treatment (P¼0.009), and lowest mortality rate (P¼0.002) compared with all groups. Two-way analysis of variance and least-squares means were calculated for each combination of variables. The overall practice effect was contrasted to the potential for mortality and was insignificant; however, their interaction effect (P¼0.003) was significant and produced the best results. Conclusions: Independence and the potential for simulated mortality have a greater impact on performance in follow-up simulations when combined than either factor alone.

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“…Simulation can provide experiences that may not be available in traditional clinical environments 10. It can allow the learner to experience rare but potentially catastrophic clinical events in order to be better equipped to act appropriately in real life 11. Simulation can also provide a safe learning environment in which to reflect on mortality and learn from the results of provider actions (or inactions) without actually harming a patient 10.…”

Section: Introductionmentioning

confidence: 99%

“…The concept of enhanced learning through stress has held true in simulation as well: DeMaria et al demonstrated that emotional stressors canincrease participant performance in simulated cardiopulmonary arrest 13. Likewise, Goldberg et al demonstrated enhanced participant learning and improved performance among residents when simulated death as a result of clinician failure was allowed to occur 11. However, other studies have suggested that emotional stress can detract from one’s ability to learn.…”

Section: Introductionmentioning

confidence: 99%

Simulated death enhances learner attitudes regarding simulation

et al. 2017

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IntroductionDespite the widespread use of simulated death in healthcare education, some view it as a controversial learning tool due to potential psychological harm. Others believe that allowing death during simulation enhances participant learning. Sparse data exist in the literature about learner attitudes towards simulated death. Our objective was to establish a link between exposure to simulated death and learner attitudes regarding simulation. Our hypothesis was that exposure to simulated death will positively affect learner attitudes towards simulation.MethodsAnonymous surveys were distributed to participants of simulations conducted by our department from January 2014 to December 2015. Collected survey data included total number of simulation scenarios, exposure to death and participants’ views towards simulation afterwards. Participants also rated the simulation on a Likert scale. We compared demographic and simulation data for participants who experienced simulated death versus participants who did not. Exposure to death and clinical level were included as predictor variables in logistic regressions using the simulator experience variables as outcomes.Results250 survey responses were analysed. 64% of participants were attendings. 82% of participants experienced death during simulation. The group that experienced simulated death gave significantly higher ratings (4.77 vs 4.50, p=0.004) and a higher percentage of maximum ratings on the Likert scale (83% vs 59%, p=0.0002). More participants who experienced death thought that simulated death could enhance learning (76% vs 59%, p=0.021). When adjusted for training level, those who experienced death in simulation were nearly twice as likely to think that death can enhance learning (p=0.049) and 133% more likely to give the simulation the highest rating (p=0.036).ConclusionsSurvey participants who experienced simulated death were more likely to think that death can enhance learning and more likely to give the simulation the highest rating, thereby demonstrating that exposure to simulated death positively affects learner attitudes regarding simulation.

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Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice

Cited by 25 publications

References 27 publications

Performance gaps and improvement plans from a 5-hospital simulation programme for anaesthesiology providers: a retrospective study

Performance gaps and improvement plans from a 5-hospital simulation programme for anaesthesiology providers: a retrospective study

Knowledge retention after simulated crisis: importance of independent practice and simulated mortality

Simulated death enhances learner attitudes regarding simulation

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