Impact of Unexpected Death in Simulation: Skill Retention, Stress and Emotions

Not Applicable

Completed

• Conditions: Stress; Crisis Resource Management (CRM) Skills; Advanced Cardiovascular Life Support (ACLS) Skills
• Interventions: Other: Unexpected death

• Registration Number: NCT03441425
• Lead Sponsor: Ottawa Hospital Research Institute

Brief Summary

Some educational researchers deliberately induce stress upon learners to in order to enhance retention; this practice is controversial and its utility must be weighed against the negative emotional effects it may have on participants. In this study we investigate the effect of the unexpected death of a simulation mannequin on the retention of non-technical and technical crisis resource management skills and consider the emotional impact of this acute stressor.

Detailed Description

Background High-fidelity simulation is an increasingly used teaching tool that is proven to be effective for learning. According to the literature, by gradually increasing stress and emotions, more effective learning can be achieved. However, allowing the simulated patient to "die", as a deliberate stressor, is controversial. There is no previous research on the educational effect of letting a simulated patient die. We aim to evaluate the effects of simulated unexpected death on skill retention, stress levels, and emotions. We hypothesize that the occurrence of unexpected death will impact skill retention, and will be associated with higher stress levels and stronger emotions.

Methods After Institutional Research Ethics Board approval, 56 residents and fellows of different medical specialties will be randomized to either the intervention (unexpected death) or control (survive) group. Participants from both groups will have to individually manage a simulated cardiac arrest crisis. In the intervention group, the scenario will end by the death of the simulated patient, whilst in the control group the simulated patient will survive. Each participant will be immediately debriefed by a trained instructor. Three months later, skill retention will be assessed in a similar scenario. Crisis management performance of all scenarios will be rated by 2 blinded raters. Biological stress, cognitive appraisal, and emotions will be measured during both scenarios.

Implications The impact of simulated unexpected death on skill retention of residents and fellows will provide instructors with evidence to optimize scenario design and approach the role of stress and emotions in simulation-based education.

Study Timeline

• Study Start: 2014-11-10
• Study First Submitted: 2018-02-15
• Study First Submitted QC: 2018-02-15
• Study First Posted: 2018-02-22
• Primary Completion: 2018-06-01
• Study Completion: 2018-06-01
• Status Verified: 2020-03
• Last Update Submitted: 2020-03-20
• Last Update Posted: 2020-03-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 54

Inclusion Criteria

• Must be a resident or a fellow in the department of anesthesiology, critical care, emergency medicine, medicine, obstetrics and gynecology, surgery or family medicine at the University of Ottawa or the University of Toronto
• Participants are requested to refrain from physical strains, smoking, drinking caffeinated or low pH beverages and eating for at least one hour before enrollment
• Participants will be included between 11 AM and 8 PM, when cortisol levels are most stable

Exclusion Criteria

• Not a resident or fellow in one of the departments indicated above

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Unexpected death	Unexpected death	The experimental group participants will complete a cardiac arrest simulation scenario on the first day in which the mannequin unexpectedly dies at the end of the scenario. They will then complete a retention simulation session three months later.

Primary Outcome Measures

Name	Time	Method
Non-technical Crisis Resource Management (CRM) skills	3 months	Assessed using the Ottawa Global Rating Scale

Secondary Outcome Measures

Name	Time	Method
Technical CRM skills	3 months	Assessed using a checklist derived from the American Heart Association's Megacode Checklist
Salivary cortisol	5 time points during each of the 2 simulation days	Biomarker of stress
Positive and Negative Affect Schedule (PANAS)	1 time point during each of the 2 simulation days	Classification of emotions experienced
State-trait anxiety inventory	3 time points during each of the 2 simulation days	Self-perceived anxiety questionnaire
Cognitive appraisal	2 time points during each of the 2 simulation days	Ratio of perceived preparedness versus demands of a task

Trial Locations

Locations (2)

The Ottawa Hospital; 🇨🇦 Ottawa, Ontario, Canada

Mount Sinai Hospital; 🇨🇦 Toronto, Ontario, Canada