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Presimulation Instruction of Technical Skills to Enhance Simulation-Based Education of Non-Technical Skills: A
Nicholas Robillard1, Christian Vincelette, Arnaud Robitaille
1From the Department of Medicine, Critical Care Service, Centre Hospitalier de l'Université de Montréal (CHUM); Simulation Centre, Académie CHUM, Centre de Recherche en Pédagogie de la Santé, Faculté de Médecine, Université de Montréal; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Québec (N.R.); Faculty of Nursing, Université de Montréal, Montréal; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Québec (C.V.); Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Québec (A.R.); Department of Pediatrics, Division of Emergency, University of Ottawa, Ontario (T.V.); Department of Anesthesiology and Pain Medicine, Montfort Hospital, University of Ottawa, Ontario (M.A.); Department of Family Medicine and Department of Innovation in Medical Education, University of Ottawa, Ontario; Institut du Savoir Montfort, Ottawa, Ontario (R.W.); Department of Medicine, McGill University, Montréal, Québec, Canada (M.T.-S.); Zamierowski Institute for Experiential Learning, University of Kansas Medical Center and Health System, Kansas City, KS (M.L.); Department of Medical Education, University of Illinois at Chicago, IL (R.Y.); Department of Innovation in Medical Education, University of Ottawa, Ontario, Canada (V.L.); and Department of Medical Education; University of Illinois at Chicago, IL (A.T.).
Introduction:
Teamwork practice through simulation-based education (SBE) is effective, but optimal instructional design remains uncertain. Preinstruction targeting technical skills (TS) and non-TS (NTS) has shown promise in supporting their respective acquisition through simulation. However, evidence remains limited on whether preteaching TS can enhance NTS acquisition, such as crisis resource management (CRM). This study aims to assess the impact of presimulation instruction of TS on the acquisition of CRM during SBE.
Methods:
We used a convergent mixed-method design, combining a quantitative post-test-only control group design with a complementary qualitative component. The intervention group had access to preinstruction of the TS necessary for managing an acutely ill patient, whereas the control group was exposed to a sham video. The main outcome was CRM skills acquisition, as measured by the Ottawa Global Rating Scale (OGRS) after 2 SBE sessions held 3 months apart (T 0 and T 3 ). Secondary objectives were the intervention's effect on anxiety, cognitive load, and participants' perceptions of the intervention. Quantitative outcomes were assessed with a repeated-measures general linear model. Semistructured interviews were conducted after each simulation, and thematic analyses were performed.
Results:
Sixty-four postgraduate year 1 (PGY1) residents were randomized into intervention and control groups. Participants who received preinstruction of TS in addition to SBE of NTS achieved significantly higher overall OGRS scores than those who received SBE of NTS alone. There were no between-group differences in anxiety measures. Qualitative analysis revealed high variability in the intervention's impact on participants, some revealing lower cognitive load, whereas others heightened levels of performance anxiety.
Conclusions:
In PGY1 residents, preinstruction of TS may reduce cognitive load during simulation training and enhance CRM skill acquisition at 3 months, although not via anxiety reduction. Responsiveness to the study intervention was variable and highlights the need for further research on the impact of instructional design adaptations on different learner subsets.
