Ageing
Conditions
Keywords
Continuing Medical Education, Simulation, Non-technical Skills, Crisis Resource Management
Brief summary
The proportion of older acute care physicians (ACPs) has been increasing. Ageing is associated with physiological changes and research investigating how such age-related physiological changes affect clinical performance is lacking. Specifically, Crisis Resource Management (CRM) consists of essential clinical skills in acute care specialties which when absent, can significantly impact patient safety. As such, the goals of this study are to investigate whether ageing has a correlation with baseline CRM skills of ACPs and whether ageing influences learning from high fidelity simulation.
Detailed description
The proportion of older acute care physicians (ACP), emergency, critical care & anesthesia, has been steadily increasing. Ageing is associated with physiological changes, which in turn can influence a physician's clinical abilities and decision-making. The litigation and physician disciplinary data suggests that incidents involving all physicians are likely to occur later in practice, with degree of injury identified in the claims being of greater severity. However research, investigating how age-related physiological changes affect clinical performance and patient safety, is lacking. CRM skills are essential skills within acute care specialties, and are vital for patient safety. CRM encompasses technical skills, as well as a rapid and organized approach to non-technical, cognitive skills such as decision-making, task management, situational awareness and team management. High-fidelity full body mannequin simulation-based education is effective for learning CRM, including transfer of skills from the simulated setting to the clinical setting and improving patient outcome. However, there is a gap in the literature on whether physicians' age influences baseline CRM performance and also learning from simulation-based education. Although the effectiveness of high-fidelity simulation-based education has been studied extensively in junior learner populations (students, residents, fellows), there are a limited number of studies investigating its effectiveness in teaching CRM in the ageing physician population. In fact, a recent systematic review looking at the role of simulation in continuing medical education (CME) in ACPs supported that there is limited evidence supporting improved learning. Despite not knowing whether simulation is the correct tool in an ageing population, it is being recommended as a training, regulation and assessment tool for practicing physicians. Objectives: The goals of this study are to: 1. Investigate whether ageing has a correlation with baseline CRM skills of ACPs using simulated crisis scenarios and 2. Assess whether ageing influences learning from high fidelity simulation.
Interventions
OTHERCRM Simulation
Each participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test.
Sponsors
University of Toronto
University of Ottawa
Sunnybrook Health Sciences Centre
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Emergency physicians * Critical care physicians * Anesthesiologists * minimum 5 years of practice post-residency
Exclusion criteria
* Post-call day of participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| CRM Performance During First Sim Scenario Assessed by Ottawa Global Rating Scale (GRS) | After managing first simulation scenario - Day 1 | Ottawa GRS score correlated with chronological age. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance. |
| CRM Performance During First Sim Scenario Assessed by ACLS Checklist | After managing first simulation scenario - Day 1 | ACLS (Advanced Cardiac Life Support) score will be correlated with chronological age. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Learning From High-fidelity Simulation Education Assessed by Ottawa Global Rating Scale | After managing second simulation scenario - Day 1 | Ottawa GRS score will be compared to score in first scenario to look for improvement. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance. The mean difference in GRS score between pre-test (scenario 1) and immediate post-test (scenario 2) is reported. |
| Learning From High-fidelity Simulation Education Assessed by ACLS Checklist | After managing second simulation scenario - Day 1 | ACLS (Advanced Cardiac Life Support) score will be compared to score in first scenario to look for improvement. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance. The mean difference in ACLS score between pre-test (scenario 1) and immediate post-test (scenario 2) is reported. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Retention of Learning From Simulation as Assessed by Ottawa Global Rating Scale | 3 months after completing first two scenarios - Day 90 | Ottawa GRS score will be compared to score in second scenario on Day 1 to look for improvement. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance. The mean difference in GRS score between immediate post-test (scenario 2) and retention post-test (scenario 3) is reported. |
| Retention of Learning From Simulation as Assessed by ACLS Checklist | 3 months after completing first two scenarios - Day 90 | ACLS (Advanced Cardiac Life Support) score will be compared to score in second scenario on Day 1 to look for improvement. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance. The mean difference in ACLS score between immediate post-test (scenario 2) and retention post-test (scenario 3) is reported. |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| CRM Simulation Each participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test. | 48 |
| Total | 48 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Lost to Follow-up | 2 |
Baseline characteristics
| Characteristic | CRM Simulation | — |
|---|---|---|
| Age, Categorical <45 | 15 Participants | — |
| Age, Categorical 45-54 | 20 Participants | — |
| Age, Categorical 55-64 | 10 Participants | — |
| Age, Categorical 65+ | 3 Participants | — |
| Age, Continuous | 49.5 years | — |
| Biological Age, Categorical <45 | 32 Participants | — |
| Biological Age, Categorical 45-54 | 9 Participants | — |
| Biological Age, Categorical 55-64 | 4 Participants | — |
| Biological Age, Categorical 65+ | 3 Participants | — |
| Biological Age, Continuous | 43.4 years | — |
| Enrollment Site University of Ottawa | 14 Participants | — |
| Enrollment Site University of Toronto | 34 Participants | — |
| Have you ever been an ACLS Instructor? No | 38 Participants | — |
| Have you ever been an ACLS Instructor? Yes | 10 Participants | — |
| Previous Full-body Manikin Simulation Scenarios Completed 0-5 | 28 Participants | — |
| Previous Full-body Manikin Simulation Scenarios Completed 11-15 | 7 Participants | — |
| Previous Full-body Manikin Simulation Scenarios Completed 16-20 | 0 Participants | — |
| Previous Full-body Manikin Simulation Scenarios Completed >20 | 4 Participants | — |
| Previous Full-body Manikin Simulation Scenarios Completed 6-10 | 9 Participants | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Sex: Female, Male Female | 20 Participants | — |
| Sex: Female, Male Male | 28 Participants | — |
| Specialty Anesthesia | 35 Participants | — |
| Specialty Emergency | 8 Participants | — |
| Specialty Intensive care | 5 Participants | — |
| What Percentage of Practice Time do you Manage ACLS Crises? 0-10% | 36 Participants | — |
| What Percentage of Practice Time do you Manage ACLS Crises? 11-20% | 9 Participants | — |
| What Percentage of Practice Time do you Manage ACLS Crises? 21-30% | 0 Participants | — |
| What Percentage of Practice Time do you Manage ACLS Crises? 31-40% | 1 Participants | — |
| What Percentage of Practice Time do you Manage ACLS Crises? 41-50% | 0 Participants | — |
| What Percentage of Practice Time do you Manage ACLS Crises? >50% | 2 Participants | — |
| Years in Practice 0-10 | 10 Participants | — |
| Years in Practice 11-20 | 20 Participants | — |
| Years in Practice 21-30 | 13 Participants | — |
| Years in Practice 31-40 | 4 Participants | — |
| Years in Practice 41-50 | 0 Participants | — |
| Years in Practice >50 | 1 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 48 |
| other Total, other adverse events | 0 / 48 |
| serious Total, serious adverse events | 0 / 48 |
Outcome results
Primary
CRM Performance During First Sim Scenario Assessed by ACLS Checklist
ACLS (Advanced Cardiac Life Support) score will be correlated with chronological age. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance.
Time frame: After managing first simulation scenario - Day 1
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| CRM Simulation | CRM Performance During First Sim Scenario Assessed by ACLS Checklist | ACLS correct score | -0.438 Pearson correlation coefficient |
| CRM Simulation | CRM Performance During First Sim Scenario Assessed by ACLS Checklist | ACLS risk score | 0.143 Pearson correlation coefficient |
Comparison: ACLS correct scorep-value: <0.01Pearson correlation
Comparison: ACLS risk scorep-value: 0.322Pearson correlation
Primary
CRM Performance During First Sim Scenario Assessed by Ottawa Global Rating Scale (GRS)
Ottawa GRS score correlated with chronological age. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance.
Time frame: After managing first simulation scenario - Day 1
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| CRM Simulation | CRM Performance During First Sim Scenario Assessed by Ottawa Global Rating Scale (GRS) | -0.299 Pearson correlation coefficient |
p-value: 0.039Pearson correlation
Secondary
Learning From High-fidelity Simulation Education Assessed by ACLS Checklist
ACLS (Advanced Cardiac Life Support) score will be compared to score in first scenario to look for improvement. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance. The mean difference in ACLS score between pre-test (scenario 1) and immediate post-test (scenario 2) is reported.
Time frame: After managing second simulation scenario - Day 1
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| CRM Simulation | Learning From High-fidelity Simulation Education Assessed by ACLS Checklist | ACLS correct score | 1.69 Score on a scale |
| CRM Simulation | Learning From High-fidelity Simulation Education Assessed by ACLS Checklist | ACLS risk score | -1.09 Score on a scale |
Secondary
Learning From High-fidelity Simulation Education Assessed by Ottawa Global Rating Scale
Ottawa GRS score will be compared to score in first scenario to look for improvement. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance. The mean difference in GRS score between pre-test (scenario 1) and immediate post-test (scenario 2) is reported.
Time frame: After managing second simulation scenario - Day 1
| Arm | Measure | Value (MEAN) |
|---|---|---|
| CRM Simulation | Learning From High-fidelity Simulation Education Assessed by Ottawa Global Rating Scale | 2.28 Score on a scale |
Other Pre-specified
Retention of Learning From Simulation as Assessed by ACLS Checklist
ACLS (Advanced Cardiac Life Support) score will be compared to score in second scenario on Day 1 to look for improvement. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance. The mean difference in ACLS score between immediate post-test (scenario 2) and retention post-test (scenario 3) is reported.
Time frame: 3 months after completing first two scenarios - Day 90
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| CRM Simulation | Retention of Learning From Simulation as Assessed by ACLS Checklist | ACLS correct score | -0.34 Score on a scale |
| CRM Simulation | Retention of Learning From Simulation as Assessed by ACLS Checklist | ACLS risk score | 0.30 Score on a scale |
Other Pre-specified
Retention of Learning From Simulation as Assessed by Ottawa Global Rating Scale
Ottawa GRS score will be compared to score in second scenario on Day 1 to look for improvement. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance. The mean difference in GRS score between immediate post-test (scenario 2) and retention post-test (scenario 3) is reported.
Time frame: 3 months after completing first two scenarios - Day 90
| Arm | Measure | Value (MEAN) |
|---|---|---|
| CRM Simulation | Retention of Learning From Simulation as Assessed by Ottawa Global Rating Scale | -0.38 Score on a scale |