Does the Use of an Observer Tool During Simulation Training Improves Learning Outcomes for Cardiac Arrest Management: a Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 120
- 主要终点
- global score
研究概览
简要总结
Only approximately 10.4% of patients with out-of-hospital cardiac arrest (OHCA) survive their initial hospitalization. The very early management of cardiac arrest is indeed considered an extremely important criterion to improve patients' outcome. Despite recent advances and improved results, outcomes remain poor, especially because bystanders are not well trained to manage such a crisis situation. According to the International Liaison Committee on Resuscitation, teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest is thus an essential goal. Teaching and learning strategies are numerous and have been well described and reviewed recently. Considering initial training methods already requires attention as study results often fail to show complete and effective learning after the initial training. Educational efficiency may be improved by several means (for example use of digital media) but it is now clear that more effective training strategies, i.e. those focusing on the cognitive process which leads to inclusion in memory), are needed.
One recently introduced strategy, mainly in the field of simulation, is the use of observer tools. It has been shown that although effectiveness was still poorly demonstrated, this method had the potential to improve learning outcomes. An observer tool is a document which is used by observers during a scenario played by other learners and immediately compares the player's technical or non-technical skills with a referential guide.
As it has been shown that observers learn less than those on the "hot seat" and as time for training is limited and the number of trainees is huge, focusing on observers is important. By visually assessing the practice of others repeatedly during the course and comparing each performance to the reference (i.e. the observer tool), the learner may increase his engagement in the training process with an expected final result of improved training efficacy.
In a previous study performed in our simulation center, it has been have shown that using an observer tool increases immediate learning scores during operating room crisis management simulation. Good data on the use of such an observer tool in other training fields is needed to confirm these preliminary positive results.
详细描述
Outcomes of cardiac arrest remain poor (1). The International Liaison Committee on Resuscitation (ILCOR) emphasizes that one essential component for good resuscitation outcomes is effective education of the lay public and resuscitation providers (2). Even when modern learning methods (i.e. for example digital aids) are used, the final result at the end of initial training can be described as providing incomplete knowledge and performance. During training sessions, it is often seen that the time during which the learners really act is short and they are positioned in a role of observer for a variable duration (but often a long proportion of the course duration). As it has been shown that observers learn less than those on the "hot seat" (3) and as time for training is limited and the number of trainees is huge, focusing on observers is important to increase the overall level of knowledge.
To increase the positive effects of the simulation when the learner is in the role of observer, some authors have proposed to strengthen the educational effect through the use of an observer tool that observers must complete by analyzing the progress of the task performed by their colleagues (4). This is a list describing the set of key points to be achieved. However, data concerning the educational value of these observer tools are limited. Studies on the use of these tools during crisis management training in the operating room assessed by high-fidelity simulation have been already conducted (5) but good data on the use of such an observer tool in other training fields is needed to confirm these preliminary positive results.
The objective of this study will be to assess the value of using an observer tool (OT) (including mainly the key points of technical performance) to improve learning outcomes of medical students during cardiac arrest training involving simulation. For medical students, learning how to manage a cardiac arrest is taught early in their curriculum, at a stage where their medical knowledge is low, and their overall competence is close to a layperson. This means that improving medical students' learning outcomes may also be a reasonable mean to improve training methods of non-medical personnel.
This prospective and randomized study will be performed in the Paris-Saclay University (LabForSIMS) simulation center.
The study will be carried out with the use of the CONSORT tool adapted for simulation studies and the GREET Tool for educational studies (6).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 50 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •2nd-year medical students
排除标准
- •unwilling to be assessed
- •absence to the training
研究组 & 干预措施
Group with an observation tool
In this group (OT +), each student will complete an observer tool each time another dyad is performing
干预措施: observer tool (Other)
Group without observation tool
In this group (OT-), the student will not use the observer tool and will observe other students without any physical support.
结局指标
主要结局
global score
时间窗: 5 minute performance at the end of the session for the procedural test
The primary outcome will be a global score describing acquisition of the skills immediately after training by comparing the groups using or not the OT (level 1-2 of the Kirkpatrick model). This score will be the sum of adequately performed items (yes/no) of the checklist which forms the observer tool itself. Although this checklist has not been validated previously, it has been constructed by experts in education, intensive care and simulation who are well aware of the constraints which are associated with such an assessment method. In addition, checklists are a usual mode of evaluation on procedural simulation. The total score is a 25 point-checklist which describes the overall performance of the dyad. Each student will also be assessed separately and points related to his (her) specific action will be counted.
次要结局
- knowledge test(15 minutes for the MCQ test)
- Global rating of the dyad teamwork score(5 minute performance at the end of the session for the procedural test)
- Q-CPR/Skill Reporter® score(5 minute performance at the end of the session for the procedural test)
研究者
Dan Benhamou
Professor of Anesthesia
Université Paris-Sud