A Blindfolded Pediatric Trauma Simulation and Its Effect on Communication and Crisis Resource Management Skills

Background  Miscommunication is a common cause of medical errors and patient harm. Simulation is a good tool to improve communication skills, but there is little literature on advanced techniques to improve closed loop communication (CLC) in an effort to minimize medical errors. This study looks to evaluate whether blindfolding simulation participants is an effective tool in improving communication, and whether this advanced teaching technique is useful for critical pediatric scenarios. Methods Participants included Emergency Medicine (EM) residents and Pediatric EM fellows with Advanced Trauma Life Support (ATLS) certification. Participants were randomized into groups and completed a pediatric trauma scenario. Recorded simulations were reviewed by three independent faculty for primary objective measures of total instances of communication and CLC utilization during critical actions in the simulation. The secondary objective was the perceived stress load by participants when utilizing this teaching methodology. Wilcoxon rank sum test (WRS), Fisher's exact test (FET), and Cochran-Armitage test (CAT) were utilized for statistical analysis. Results Statistically significant differences were noted in total communication between groups. Median and interquartile ranges (IQR) of total instances of communication were 17.0 (14.7-17.1) in non-blindfolded groups versus 21.0 (19.0-22.0) in blindfolded groups (p-value=0.002). Statistically significant increase in CLC was noted during the critical action of monitor placement in the blindfolded group (OR=13.7, 95% CI=1.4-133.8). No differences were noted in crisis resource management (CRM) scores. NASA Task Load Index (NASA-TLX) scores of both groups revealed similar stress levels. Statistical testing based upon the year of training was limited by small sample size and large number of categories. Conclusions Blindfolded simulations increased total instances of communication overall and improved CLC in one critical action without increasing stress levels. The blindfolded trauma simulation exercise is an effective advanced technique to reinforce CLC utilization and communication skills.