Medical Education, Simulation, Crisis Resource Management
Conditions
Keywords
Medical Education, Simulation, Crisis Resource Management
Brief summary
This is a randomized controlled trial examining the effectiveness of a teaching intervention on residents' and medical students' ability to challenge clearly wrong decisions by a superior during a simulated life-threatening crisis. Participants will be randomly allocated into the control or intervention arm. The intervention arm will receive education on crisis resource management (CRM) and teaching targeting the cognitive skills required to monitor and challenge a superior's decision, and conflict resolution tools. Participants will then take part in a simulation scenario 2 to 4 weeks later and will be assessed based on 6 challenge points, followed by a debrief session.
Interventions
OTHERCrisis Resource Management Skill Training
Focused crisis resource management training which targets at the cognitive skills needed to monitor and challenge a superior's decision.
OTHERStandard ACLS Training
Standard didactic interactive session on Advanced Cardiac Life Support (ACLS) principles.
Sponsors
National University Hospital, Singapore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Masking description
Deliberate deception (by not informing of the aim of assessing for ability to challenge authority) will be used to blind the participants. However, open disclosure and explanation of the rationale for deception will be conducted during the debriefing sessions and participants will be extensively counselled. The confederate specialist will also be blinded to the allocation of the control or intervention arm of participants. All sessions will be video recorded and assessed in random order by two independent raters blinded to group allocation, using the modified Advocacy-Inquiry Score (mAIS).
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Medical officers or Internal medicine, surgical and emergency medicine residents who are in their 2nd post-graduate year of training, or * Phase V medical students from Yong Loo Lin School of Medicine, National University of Singapore
Exclusion criteria
* Refusal for informed consent, or * Refusal for video recording during simulation sessions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effect of a teaching intervention on participants' ability to challenge clearly wrong decisions by a superior during a simulated life-threatening crisis | 20 minutes | Comparison of the best modified Advocacy-Inquiry Score (mAIS) responses of the 6 challenge opportunities between the intervention and control groups. The mAIS is a modification of the Advocacy-Inquiry method which includes five scoring levels with the addition of a sixth level when a trainee attempts to take over management of the case. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Influence of the confederate's gender on participant's ability to challenge incorrect decisions | 20 minutes | Comparison of the median modified Advocacy-Inquiry Score (mAIS) responses between the subjects exposed to male versus female confederate specialist. The mAIS is a modification of the Advocacy-Inquiry method which includes five scoring levels with the addition of a sixth level when a trainee attempts to take over management of the case. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Qualitative analysis of themes surrounding hierarchy and challenging authority | 10 minutes | Themes elicited during open disclosure and discussion during debrief session with participants |
Countries
Singapore
Outcome results
None listed