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

International audienceBackground: 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

Les échelles des territorialités

La mondialisation, faisant apparaître, légitimant ou contribuant à la montée en puissance de territorialités très diverses, devait en toute apparence faire disparaître les frontières et les territoires, rendus obsolètes ou contre-productifs. L’argumentaire est connu, mais il résiste mal à l’examen de diverses situations concrètes. Le territoire persiste ou, mieux, se déploie : il reste l’outil privilégié d’organisation et de contrôle de l’espace. Comment expliquer cet apparent paradoxe autrement qu’en recourant à une prétendue universalité des rapports de l’homme à l’espace ? Les articles de ce numéro spécial montrent, à travers les manières dont le pouvoir pense l’espace en le découpant, ce qu’il y a de culturel et de stratégique dans le territoire. En étudiant les territorialités induites par diverses formes de mondialisation, ces articles montrent en particulier que c’est parce que ces territorialités se structurent, face au pouvoir, à certaines échelles – celles de la modernité politique – que le territoire peut se renouveler constamment

Anaesth Crit Care Pain Med

To develop a multidisciplinary French reference that addresses initial pre- and in-hospital management of a mild traumatic brain injury patient. A panel of 22 experts was formed on request from the French Society of Emergency Medicine (SFMU) and the French Society of Anaesthesiology and Critical Care Medicine (SFAR). A policy of declaration and monitoring of links of interest was applied and respected throughout the process of producing the guidelines. Similarly, no funding was received from any company marketing a health product (drug or medical device). The expert panel had to respect and follow the Grade® (Grading of Recommendations Assessment, Development and Evaluation) methodology to evaluate the quality of the evidence on which the recommendations were based. Given the impossibility of obtaining a high level of evidence for most of the recommendations, it was decided to adopt a "Recommendations for Professional Practice" (RPP) format, rather than a Formalized Expert Recommendation (FER) format, and to formulate the recommendations using the terminology of the SFMU and SFAR Guidelines. Three fields were defined: 1) pre-hospital assessment, 2) emergency room management, and 3) emergency room discharge modalities. The group assessed 11 questions related to mild traumatic brain injury. Each question was formulated using a PICO (Patients Intervention Comparison Outcome) format. The experts' synthesis work and the application of the GRADE® method resulted in the formulation of 14 recommendations. After two rounds of rating, strong agreement was obtained for all recommendations. For one question, no recommendation could be made. There was strong agreement among the experts on important, transdisciplinary recommendations, the purpose of which is to improve management practices for patients with mild head injury