A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada.

PurposeHigh-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other.MethodsThis study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve.ResultsSelf-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can300, instructor debriefing was the preferred alternative.ConclusionWith a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education

Le moment choisi pour faire des séances de rappel n’améliorerait pas la conservation des compétences acquises en réanimation par les professionnels de la santé : un essai contrôlé randomisé

Introduction: Booster sessions can improve cardiopulmonary resuscitation (CPR) skill retention among healthcare providers; however, the optimal timing of these sessions is unknown. This study aimed to explore differences in skill retention based on booster session timing. Methods: After ethics approval, healthcare providers who completed an initial CPR training course were randomly assigned to either an early booster, late booster, or no booster group. Participants’ mean resuscitation scores, time to initiate compressions, and time to successfully provide defibrillation were assessed immediately post-course and four months later using linear mixed models. Results: Seventy-three healthcare professionals were included in the analysis. There were no significant differences by randomization in the immediate post-test (9.7, 9.2, 8.9) or retention test (10.2, 9.8, and 9.5) resuscitation scores. No significant effects were observed for time to compression. Post-test time to defibrillation (mean ± SE: 112.8 ± 3.0 sec) was significantly faster compared to retention (mean ± SE: 120.4 ± 2.7 sec) (p = 0.04); however, the effect did not vary by randomization. Conclusion: No difference was observed in resuscitation skill retention between the early, late, and no booster groups. More research is needed to determine the aspects of a booster session beyond timing that contribute to skill retention.Introduction : Les séances de rappel peuvent favoriser la conservation des compétences en réanimation cardio-pulmonaire (RCP) chez les professionnels de la santé; toutefois, le moment optimal pour offrir ces séances est inconnu. Cette étude visait à explorer les différences dans la conservation de compétences en fonction du moment où intervient la séance de rappel. Méthodes : Après avoir obtenu une approbation éthique, nous avons réparti, au hasard, des professionnels de la santé ayant suivi une formation initiale en RCP entre un groupe de rappel précoce, un groupe de rappel tardif et un groupe qui ne reçoit pas de séance de rappel. Les scores moyens des participants pour la réussite de la réanimation, le temps moyen pris avant de commencer les compressions et le temps moyen pris pour effectuer avec succès la défibrillation ont été évalués immédiatement après la séance et quatre mois plus tard à l’aide de modèles mixtes linéaires. Résultats : Soixante-treize professionnels de la santé ont participé à l’étude. Il n’y a pas eu de différences significatives selon la randomisation dans les scores de réanimation du post-test immédiat (9,7; 9,2; 8,9) et du test sur la conservation des compétences (10,2; 9,8 et 9,5). Aucun effet significatif n’a été observé pour le délai avant d’entamer les compressions. Le délai pour la défibrillation était significativement plus court après la séance (moyenne ± SE : 112,8 ± 3,0 sec) que lors du test de conservation des compétences (moyenne ± SE : 120,4 ± 2,7 sec) (p=0,04); cependant, l’effet ne variait pas selon la randomisation. Conclusion : Aucune différence n’a été observée sur le plan de la conservation des compétences en réanimation entre les groupes de rappel précoce, de rappel tardif et d’absence de rappel. De plus amples recherches sont nécessaires pour déterminer les facteurs d’une séance de rappel, autres que le moment où elle intervient, qui contribueraient à la conservation des compétences

S’outiller pour mieux participer à la rétroaction : Un nouveau modèle cognitivo-comportemental destiné aux apprenants en médecine

Sharing formative feedback is inherent in the supervision process and the acceptance of feedback by learners is an essential step in learning. However, receiving feedback from the supervisor evokes emotions and accepting it is not easy. Several recommendations guide preceptors on how to share feedback with learners and all emphasize the importance of encouraging the learner to actively interact in the feedback process. Although studies point to the positive effect of informing and training learners about feedback, few focus on their responsiveness to feedback. Under the rubric of developing a personal skill to better accept feedback, we propose a new behavioral model, called H.O.S.T., which aims to guide learners to approach feedback with a personal growth mindset associated with the learning position. Specifically, the model presents an interdependent set of attitudes and behaviors that aim to facilitate emotional management and engagement in the feedback process, in order to initiate the reflective process necessary for learning and to enable the acquisition of targeted skills. The acronym H.O.S.T. reminds students of the four essential elements of the behavioral model: humility, openness, shared explicitness and tenacity. Based on the positive psychology movement, each element is defined and justified by known theoretical concepts. In order to better assimilate the components of the model, the use of internal dialogue is adopted to facilitate the training and adoption of behaviors. The essence of the model is discussed in light of the feedback literacy dedicated to learners. Translated with www.DeepL.com/Translator (free version)Le partage de commentaires formatifs est inhérent au processus de supervision et l'acceptation de la rétroaction par les apprenants est une étape essentielle à l'apprentissage. Cependant, recevoir des commentaires du superviseur suscite des émotions et les accepter n'est pas facile. Plusieurs recommandations guident les superviseurs sur la façon de partager leurs observations aux apprenants et toutes soulignent l’importance d’encourager l'apprenant à interagir de façon active au processus de rétroaction. Bien que des études dénotent l’effet positif d’informer et de former les apprenants sur la rétroaction, peu s’attardent à les outiller à mieux réagir à la rétroaction. Fondés sur les observations de superviseurs expérimentés, nous proposons un modèle cognitivo-comportemental qui vise à guider les apprenants à aborder la rétroaction avec un état d'esprit de croissance personnelle associé à la position d’apprentissage. Sous le registre de l’acquisition d’une compétence personnelle destinée à mieux accepter les commentaires, le modèle présente un ensemble interdépendant d’attitudes et de comportements destiné à faciliter la gestion des émotions, l’auto-réflexion et l’engagement dans le processus de rétroaction nécessaires à l’apprentissage et à l’acquisition de compétences. L’acronyme H.O.T.E. rappelle aux étudiants les quatre éléments essentiels du modèle : l'humilité, l'ouverture d'esprit, la ténacité et l'explicitation. S’inspirant du courant de la psychologie positive, chaque élément est défini et justifié par des concepts théoriques connus. Pour mieux assimiler les composantes du modèle, l’utilisation de dialogue intérieur est retenue pour faciliter l’entrainement et l’adoption des comportements. L’essence du modèle est discutée à la lumière de la littéracie en rétroaction dédiée aux apprenants

Transfer of learning and patient outcome in simulated crisis resource management : a systematic review

PURPOSE: Simulation-based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management (CRM). This systematic review was conducted to gain a better understanding of the impact of simulation-based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes. SOURCE: Studies on CRM, crisis management, crew resource management, teamwork, and simulation published up to September 2012 were searched in MEDLINE(®), EMBASE™, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC. All studies that used simulation-based CRM teaching with outcomes measured at Kirkpatrick Level 3 (transfer of learning to the workplace) or 4 (patient outcome) were included. Studies measuring only learners' reactions or simple learning (Kirkpatrick Level 1 or 2, respectively) were excluded. Two authors independently reviewed all identified titles and abstracts for eligibility. PRINCIPAL FINDINGS: Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation-based CRM learning into the clinical setting (Kirkpatrick Level 3). In three of these studies, simulation-enhanced CRM training was found significantly more effective than no intervention or didactic teaching. Five studies measured patient outcomes (Kirkpatrick Level 4). Only one of these studies found that simulation-based CRM training made a clearly significant impact on patient mortality. CONCLUSIONS: Based on a small number of studies, this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality

A BEME systematic review of the effects of interprofessional education : BEME Guide No. 39

BACKGROUND: Interprofessional education (IPE) aims to bring together different professionals to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients. Given its potential for improving collaboration and care delivery, there have been repeated calls for the wider-scale implementation of IPE across education and clinical settings. Increasingly, a range of IPE initiatives are being implemented and evaluated which are adding to the growth of evidence for this form of education. AIM: The overall aim of this review is to update a previous BEME review published in 2007. In doing so, this update sought to synthesize the evolving nature of the IPE evidence. METHODS: Medline, CINAHL, BEI, and ASSIA were searched from May 2005 to June 2014. Also, journal hand searches were undertaken. All potential abstracts and papers were screened by pairs of reviewers to determine inclusion. All included papers were assessed for methodological quality and those deemed as "high quality" were included. The presage-process-product (3P) model and a modified Kirkpatrick model were employed to analyze and synthesize the included studies. RESULTS: Twenty-five new IPE studies were included in this update. These studies were added to the 21 studies from the previous review to form a complete data set of 46 high-quality IPE studies. In relation to the 3P model, overall the updated review found that most of the presage and process factors identified from the previous review were further supported in the newer studies. In regard to the products (outcomes) reported, the results from this review continue to show far more positive than neutral or mixed outcomes reported in the included studies. Based on the modified Kirkpatrick model, the included studies suggest that learners respond well to IPE, their attitudes and perceptions of one another improve, and they report increases in collaborative knowledge and skills. There is more limited, but growing, evidence related to changes in behavior, organizational practice, and benefits to patients/clients. CONCLUSIONS: This updated review found that key context (presage) and process factors reported in the previous review continue to have resonance on the delivery of IPE. In addition, the newer studies have provided further evidence for the effects on IPE related to a number of different outcomes. Based on these conclusions, a series of key implications for the development of IPE are offered

Mapping multicenter randomized controlled trials in anesthesiology: a scoping review

Background: Evidence suggests that there are substantial inconsistencies in the practice of anesthesia. There has not yet been a comprehensive summary of the anesthesia literature that can guide future knowledge translation interventions to move evidence into practice. As the first step toward identifying the most promising interventions for systematic implementation in anesthesia practice, this scoping review of multicentre RCTs aimed to explore and map the existing literature investigating perioperative anesthesia-related interventions and clinical patient outcomes. Methods: Multicenter randomized controlled trials were eligible for inclusion if they involved a tested anesthesia-related intervention administered to adult surgical patients (≥ 16 years old), with a control group receiving either another anesthesia intervention or no intervention at all. The electronic databases Embase (via OVID), MEDLINE, and MEDLINE in Process (via OVID), and Cochrane Central Register of Control Trials (CENTRAL) were searched from inception to February 26, 2021. Studies were screened and data were extracted by pairs of independent reviewers in duplicate with disagreements resolved through consensus or a third reviewer. Data were summarized narratively. Results: We included 638 multicentre randomized controlled trials (n patients = 615,907) that met the eligibility criteria. The most commonly identified anesthesia-related intervention theme across all studies was pharmacotherapy (n studies = 361 [56.6%]; n patients = 244,610 [39.7%]), followed by anesthetic technique (n studies = 80 [12.5%], n patients = 48,455 [7.9%]). Interventions were most often implemented intraoperatively (n studies = 233 [36.5%]; n patients = 175,974 [28.6%]). Studies typically involved multiple types of surgeries (n studies = 187 [29.2%]; n patients = 206 667 [33.5%]), followed by general surgery only (n studies = 115 [18.1%]; n patients = 201,028 [32.6%]) and orthopedic surgery only (n studies = 94 [14.7%]; n patients = 34,575 [5.6%]). Functional status was the most commonly investigated outcome (n studies = 272), followed by patient experience (n studies = 168), and mortality (n studies = 153). Conclusions: This scoping review provides a map of multicenter RCTs in anesthesia which can be used to optimize future research endeavors in the field. Specifically, we have identified key knowledge gaps in anesthesia that require further systematic assessment, as well as areas where additional research would likely not add value. These findings provide the foundation for streamlining knowledge translation in anesthesia in order to reduce practice variation and enhance patient outcomes

lnterprofessional simulation crisis resource management training in the operating room : a mixed method study

Cette thèse a pour objet la formation d’équipes de professionnels de santé aux situations d’urgence vitale. Notre travail se focalise sur des techniques innovantes de simulation pour des équipes interprofessionnelles, et notamment son cœur : le débriefing. Plusieurs travaux ont montré que des débriefings sans instructeur pouvaient être efficaces pour l’apprentissage individuel. Mais aucune étude n’avait exploré le débriefing en équipe sans instructeur pour l’amélioration de la performance d’équipe. Or la prise en charge d’un patient en situation d’urgence vitale est presque systématiquement du ressort d’une équipe. Grâce à l’association de méthodologies de recherche quantitative et qualitative, nous avons évalué l’efficacité et analysé le contenu de l’auto-débriefing en équipe sans instructeur pour améliorer la performance de prise en charge d’urgences vitales par des équipes interprofessionnelles. Ce travail permet d’optimiser la formation des instructeurs et de faciliter la diffusion des formations interprofessionnelles par simulation.This thesis aims at training healthcare teams in life-threatening emergency situations. Our work focuses on innovative simulation techniques for interprofessional teams, and especially its heart: the debriefing. Several studies have shown that debriefing without instructor could be effective for individual learning. But no study has yet explored team debriefing without instructor as a possible approach to improving team performance. However patient care in emergency life-threatening situations is almost always the responsibility of a team. Combining quantitative and qualitative research methodologies, we evaluated the effectiveness and analyzed the content of within-team debriefing without instructor to improve performance of life-threatening emergencies management by interprofessional teams. This work optimizes instructor training, and facilitates diffusion of simulation-based interprofessional training