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Impact of ongoing clinical experience on advanced life support provider performance in multicasualty simulations
Stav Regev1, Tomer Talmy, Shaul Gelikas
1From the Department of Pediatrics (S.R.), Lady Davis, Carmel Medical Center, Haifa; Israel Defense Forces Medical Corps (T.T., S.G., I.Y.M.), Tel Hashomer, Ramat Gan; Department of Military Medicine (T.T., S.G., I.Y.M.), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem; Trauma and Combat Medicine Branch (T.T., S.G., I.Y.M.), Israel Defense Force Medical Corps, Tel HaShomer; Division of Anesthesia (T.T.), Intensive Care, and Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv; Division of Internal Medicine (S.G.), Sheba Medical Center, Tel HaShomer; Military Medical Academy (I.Y.M.), Israel Defense Force, Ha'Negev; Gray Faculty of Medicine (I.Y.M.), Tel Aviv University, Tel Aviv; and Division of Orthopaedic Surgery (I.Y.M.), Shamir Medical Center, Tzrifin, Israel.
Background:
Effective response to multicasualty events may depend on the performance of advanced life support (ALS) providers. This study examines the relationship between ALS training, clinical skill maintenance through a Competency Maintenance Program, and provider performance in multicasualty event simulations.
Methods:
Military medical teams, led by Israel Defense Forces (IDF) Military Trauma Life Support (MTLS)-trained providers (physicians or paramedics), participated in a multicasualty scenario simulation. Performance was assessed using a task checklist and the Trauma Non-Technical Skills scale. Data were collected on MTLS training and participation in the Competency Maintenance Program, which mandates ALS providers to complete hospital and ambulance shifts for continuous skill maintenance. Regression analyses were conducted to evaluate the impact of these variables on simulation performance.
Results:
The study included 25 teams, the majority of which were led by paramedics (78%). Clinical experience in hospitals and ambulance services showed moderate correlations with simulation performance ( R = 0.562, p = 0.009, and R = 0.664, p = 0.003, respectively). However, ALS provider type (physician vs. paramedic) and MTLS course performance did not correlate with simulation performance ( R = 0.009, p = 0.952, and R = 0.390, p = 0.054, respectively). Simulation performance was also correlated with the teams' nontechnical skills ( R = 0.550, p < 0.001, β = 0.393, p = 0.014), which functioned as both an independent factor and a partial mediator in the relationship between ALS providers' attributes and simulation performance ( R2 = 0.725, R2 change = 0.475). Specifically, clinical experience in hospitals was directly linked to performance, whereas ambulance experience was indirectly associated with performance through its impact on nontechnical skills.
Conclusion:
Clinical skill maintenance through hospital and ambulance experience may enhance ALS providers' performance in multicasualty event simulations. These findings suggest that structured skill maintenance programs could better prepare teams for managing complex scenarios.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
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