Learning crisis resource management: Practicing versus an observational role in simulation training - a randomized...

Area of Science:

• Medical Education
• Simulation-Based Training
• Healthcare Simulation

Background:

• Simulation training is a recognized method for teaching crisis resource management (CRM) skills.
• Deliberate practice theory posits that active engagement is crucial for effective learning.
• Residency programs often face limitations in providing active simulation participation opportunities for all learners.

Purpose of the Study:

• To compare the effectiveness of learning CRM skills through active participation versus observer participation in simulation, followed by debriefing.
• To investigate whether active engagement in simulation is superior for acquiring CRM skills compared to observing and debriefing.

Main Methods:

• Participants were randomized into active or observer groups for a simulated crisis scenario (pre-test).
• Observer participants viewed the scenario via video transmission and all participants received instructor-led debriefing on CRM principles.
• Individual post-tests assessed performance, with blinded raters evaluating videos using the Ottawa Global Rating Scale (GRS).

Main Results:

• Active participants demonstrated significant improvement from pre-test to post-test (P=0.015).
• No significant difference was found in post-test performance between active participants and observer participants (P=0.12).
• Inter-rater reliability for the assessment scale was 0.64.

Conclusions:

• Learning CRM skills was not superior in active participants compared to observers who underwent debriefing.
• These findings question the necessity of active practice for learning CRM skills, as suggested by deliberate practice theory.
• Observer participation in simulation, coupled with debriefing, remains a beneficial strategy for resident training.