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Dr. Adam Cheng (Vancouver, BC - BC Children's & Alberta Health Services) talks about his Scripted Debriefing study in the EXPRESS Network and the results and ramifications on resuscitation education through the American Heart Association's PALS & ACLS Programs. Originally aired March 19, 2012.
Citation preview
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Examining Pediatric Resuscitation Education using
Simulation and Scripting (EXPRESS): A Multicenter Trial
Adam Cheng, Elizabeth Hunt, Aaron Donoghue, Kristen
Nelson, Walter Eppich, Vinay Nadkarni for the EXPRESS
Investigators
• Research Grant Support– American Heart Association – EXPRESS project– Laerdal Foundation for Acute Medicine– Heart and Stroke Foundation of Canada– Canadian Institute for Health Research
• Intellectual– Pediatric Subcommittee, American Heart Association– Contributing Editor, 2011 PALS Instructor Manual
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Disclosure
• Trend:– More simulation in
standardized resuscitation courses (PALS, ACLS)
• Issue: – Thousands of instructors
across North America– Instructor debriefing skills
are variable
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Background
• Proposed Solution: Debriefing Script– Sound debriefing principles– Framework– Specific wording and phrases– Promotes reflective learning
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Debriefing Script
Multicenter Study• Prospective, RCT• Factorial design• Subjects:
– Novice Instructors– Interprofessional
pediatric healthcare teams
Assessing Simulation in Pediatrics: Improving Resuscitation Education
EXPRESS Study
Low Realism (LoR)
High Realism (HiR)
Non-Scripted Debriefing (nS)
nS - LoR nS - HiR
Scripted Debriefing (S)
S - LoR S - HiR
Assessing Simulation in Pediatrics: Improving Resuscitation Education
EXPRESS Study
Institution Investigator(s)BC Children’s Hospital Adam Cheng
Children’s Hospital of Philadelphia Vinay Nadkarni, Aaron Donoghue, Akira Nishisaki
Johns Hopkins Betsy Hunt, Kristen Nelson
Children’s Medical Center Dallas Judy Leflore, Jeffrey Hopkins
Cincinnati Children’s Mike Moyer, Mary Patterson
Children’s Memorial Hospital Walter Eppich, Mark Adler
Children’s Hospital Boston Marisa Brett-Fleegler, Monica Kleinman, Liana Kappus
Children’s Hospital at Dartmouth Matthew Braga
AI Dupont Susanne Kost, Glen Stryjewski
Walter Reed / National Naval Steve Min, John Podraza, Joe Lopreiato
Pittsburgh Children’s Melinda Fiedor-Hamilton
Stollery Children’s Hospital Jonathan Duff
Center for Medical Simulation Robert Simon, Jenny Rudolph
Seattle Children’s Hospital Kimberly Stone, Jennifer Reid
Oregon Health Sciences JoDee Anderson
• Task-based guidance
• Performed Well vs. Needs Work
• Debriefing Theory: Advocacy Inquiry
Assessing Simulation in Pediatrics: Improving Resuscitation Education
EXPRESS Script
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Debriefing Script
Assessing Simulation in Pediatrics: Improving Resuscitation Education
EXPRESS – Study Design
Interprofessional TeamInterprofessional Team
Outcome Measures- Knowledge- Behavioural Performance
- Cognitive Performance
Outcome Measures- Knowledge- Behavioural Performance
- Cognitive Performance
Simulation Scenario - PRESimulation Scenario - PRE
Simulation Scenario - POSTSimulation Scenario - POSTSimulation Scenario - POSTSimulation Scenario - POST
Non-Scripted DebriefingNon-Scripted DebriefingScripted DebriefingScripted Debriefing
Simulation Scenario - PRESimulation Scenario - PRE
n=200n=187
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Review Team
Cognitive Performance Tool (CPT)
Behavioural Assessment Tool (BAT)
Debriefing Assessment for Simulation in Healthcare (DASH)
Stephanie Sudikoff
Frank Overly
Marino Festa
Takanari Ikeyama
John Podraza
Glenn Stryjewski
Aaron Donoghue
Matthew Braga
Kathleen Ventre
Jonathan Duff
Douglas Leonard
Kristine Boyle
Laura Corbin
Mike Moyer
JoDee Anderson
Jeffrey Hopkins
Walter Eppich
Vinay Nadkarni
Akira Nishisaki
Elizabeth Hunt
Kristen Nelson
Monica Kleinman
Marisa Brett-Fleegler
Adam Cheng
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Research Portal
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Research Portal
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Research Portal
Functionality LMS Res Portal
SecurityCustom admin access Y Y
Study DesignCustom study design – arm / group / subject hierarchyAutomated or custom assignment of subject codes
NN
YY
Assessment ToolsCustom tool creationMatch assessment tools to videos
YY
YY
Video ManagementUpload of video from multiple sites with different A/V systemsCustom assignment of video to team OR individuals based on study armView review and data entry online from multiple sites
YNN
YYY
Data ManagementDownload custom spreadsheets according to study arm or outcome measure
N Y
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Results
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Validation of Assessment Tools
Assessing Simulation in Pediatrics: Improving Resuscitation Education
EXPRESS Results
Why weren’t our results more significant?
Scripted Debriefing:•One scenario – Difficulty? Enough exposure?•Length of debriefing
Realism•High emotional, conceptual and environmental realism•Enough exposure?
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Limitations
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Research Process
AHA Pediatric Subcommittee identified:•Existing PALS instructor material were inadequate•More debriefing instruction and guidance was required•Standardized method of debriefing needed to be introduced
Assessing Simulation in Pediatrics: Improving Resuscitation Education
PALS Instructor Training
• Online debriefing module
• GAS Model– Gather– Analyze– Summarize
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Structured and Supported Debriefing
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Challenge
Assessing Simulation in Pediatrics: Improving Resuscitation Education
What worked… and What Didn’t
EXPRESS Debriefing Script:
Assessing Simulation in Pediatrics: Improving Resuscitation Education
New Debriefing Tool
Assessing Simulation in Pediatrics: Improving Resuscitation Education
New Debriefing Tool
Assessing Simulation in Pediatrics: Improving Resuscitation Education
New Debriefing Tool
Assessing Simulation in Pediatrics: Improving Resuscitation Education
New Debriefing Tool
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Pilot Testing
• Structured and Supported Debriefing• Instructor Course• Instructor Manual
– New debriefing chapter– Scenario Cards
• Front : Scenario• Back : Debriefing Tool
Assessing Simulation in Pediatrics: Improving Resuscitation Education
2011 PALS Instructor Training
Assessing Simulation in Pediatrics: Improving Resuscitation Education
PALS Scenario Cards
Assessing Simulation in Pediatrics: Improving Resuscitation Education
ACLS Scenario Cards
Assessing Simulation in Pediatrics: Improving Resuscitation Education
PALS Debriefing
• Scripted debriefing helps to improve learning outcomes
• Knowledge acquired from simulation-based research can be disseminated via collaboration with established associations
• Future Directions– Research : instructor and learner feedback, compliance,
usability, learner outcomes, patient outcomes– Use of debriefing tool in non-PALS context
Effective knowledge translation = Greater Impact
Assessing Simulation in Pediatrics: Improving Resuscitation Education
Take Home Messages
Assessing Simulation in Pediatrics: Improving Resuscitation Education
INSPIRE Network
• Attend meetings / webinars
• Research– Single site studies– Multicenter studies
• Primary or site investigator
• Video reviewer• Consultant
Assessing Simulation in Pediatrics: Improving Resuscitation Education
INSPIRE Network
• Distribution List: – Nicola Robertson –
• Research:– Adam Cheng ch
[email protected]– Marc Auerbach