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The effects of active (hot-seat) versus observer roles during simulation-based training on stress levels and non-technical performance: a randomized trial.

ABSTRACT: Background:Active 'hands-on' participation in the 'hot-seat' during immersive simulation-based training (SBT) induces stress for participants, which is believed to be necessary to improve performance. We hypothesized that observers of SBT can subsequently achieve an equivalent level of non-technical performance as 'hot-seat' participants despite experiencing lower stress. Methods:We randomized 37 anaesthesia trainees into two groups to undergo three consecutive SBT scenarios. Eighteen 'hot-seat' trainees actively participated in all three scenarios, and 19 'observer' trainees were directed to observe the first two scenarios and participated in the 'hot-seat' only in scenario 3. Salivary cortisol (SC) was measured at four time points during each scenario. Primary endpoint for stress response was the change in SC (?SC) from baseline. Performance was measured using the Anaesthetist's Non-Technical Skills (ANTS) Score. Results:Mean SC increased in all participants whenever they were in the 'hot-seat' role, but not when in the observer role. Hot-seat ?SC (mcg/dL) for scenarios 1, 2, and 3 were 0.122 (p?=?0.001), 0.074 (p?=?0.047), and 0.085 (p?=?0.023), respectively. Observers ?SC (mcg/dL) for scenarios 1, 2, and 3 were -0.062 (p?=?0.091), 0.010 (p?=?0.780), and 0.144 (p?=?0.001), respectively. Mean ANTS scores were equivalent between the 'hot-seat' (40.0) and 'observer' (39.4) groups in scenario 3 (p?=?0.733). Conclusions:Observers of SBT achieved an equivalent level of non-technical performance, while experiencing lower stress than trainees repeatedly trained in the 'hot-seat'. Our findings suggest that directed observers may benefit from immersive SBT even without repeated 'hands-on' experience and stress in the hot-seat. The directed observer role may offer a less stressful, practical alternative to the traditional 'hot-seat' role, potentially rendering SBT accessible to a wider audience. Trial registration:ClinicalTrials.gov Identifier NCT02211378, registered August 5, 2014, retrospectively registered.

SUBMITTER: Bong CL

PROVIDER: S-EPMC5806270 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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The effects of active (hot-seat) versus observer roles during simulation-based training on stress levels and non-technical performance: a randomized trial.

Bong Choon Looi CL Lee Sumin S Ng Agnes Suah Bwee ASB Allen John Carson JC Lim Evangeline Hua Ling EHL Vidyarthi Arpana A

Advances in simulation (London, England) 20170320

<h4>Background</h4>Active 'hands-on' participation in the 'hot-seat' during immersive simulation-based training (SBT) induces stress for participants, which is believed to be necessary to improve performance. We hypothesized that observers of SBT can subsequently achieve an equivalent level of non-technical performance as 'hot-seat' participants despite experiencing lower stress.<h4>Methods</h4>We randomized 37 anaesthesia trainees into two groups to undergo three consecutive SBT scenarios. Eigh ...[more]

PMID: 29450008

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Project description:Background:Traditional simulation-based education prioritizes participation in simulated scenarios. The educational impact of observation in simulation-based education compared with participation remains uncertain. Our objective was to compare the performances of observers and participants in a standardized simulation scenario. Methods:We assessed learning differences between simulation-based scenario participation and observation using a convergent, parallel, quasi-experimental, mixed-methods study of 15 participants and 15 observers (N = 30). Fifteen first-year residents from six medical specialties were evaluated during a simulated scenario (cardiac arrest due to critical hyperkalemia). Evaluation included predefined critical actions and performance assessments. In the first exposure to the simulation scenario, participants and observers underwent a shared postevent debriefing with predetermined learning objectives. Three months later, a follow-up assessment using the same case scenario evaluated all 30 learners as participants. Wilcoxon signed rank and Wilcoxon rank sum tests were used to compare participants and observers at 3-month follow-up. In addition, we used case study methodology to explore the nature of learning for participants and observers. Data were triangulated using direct observations, reflective field notes, and a focus group. Results:Quantitative data analysis comparing the learners' first and second exposure to the investigation scenario demonstrated participants' time to calcium administration as the only statistically significant difference between participant and observer roles (316 seconds vs. 200 seconds, p = 0.0004). Qualitative analysis revealed that both participation and observation improved learning, debriefing was an important component to learning, and debriefing closed the learning gap between observers and participants. Conclusions:Participants and observers had similar performances in simulation-based learning in an isolated scenario of cardiac arrest due to hyperkalemia. Findings support current limited literature that observation should not be underestimated as an important opportunity to enhance simulation-based education. When paired with postevent debriefing, scenario observers and participants may reap similar educational benefits.

Project description:ImportanceTo better elucidate the role of artificial intelligence (AI) in surgical skills training requires investigations in the potential existence of a hidden curriculum.ObjectiveTo assess the pedagogical value of AI-selected technical competencies and their extended effects in surgical simulation training.Design, setting, and participantsThis cohort study was a follow-up of a randomized clinical trial conducted at the Neurosurgical Simulation and Artificial Intelligence Learning Centre at the Montreal Neurological Institute, McGill University, Montreal, Canada. Surgical performance metrics of medical students exposed to an AI-enhanced training curriculum were compared with a control group of participants who received no feedback and with expert benchmarks. Cross-sectional data were collected from January to April 2021 from medical students and from March 2015 to May 2016 from experts. This follow-up secondary analysis was conducted from June to September 2022. Participants included medical students (undergraduate year 0-2) in the intervention cohorts and neurosurgeons to establish expertise benchmarks.ExposurePerformance assessment and personalized feedback by an intelligent tutor on 4 AI-selected learning objectives during simulation training.Main outcomes and measuresOutcomes of interest were unintended performance outcomes, measured by significant within-participant difference from baseline in 270 performance metrics in the intervention cohort that was not observed in the control cohort.ResultsA total of 46 medical students (median [range] age, 22 [18-27] years; 27 [59%] women) and 14 surgeons (median [range] age, 45 [35-59] years; 14 [100%] men) were included in this study, and no participant was lost to follow-up. Feedback on 4 AI-selected technical competencies was associated with additional performance change in 32 metrics over the entire procedure and 20 metrics during tumor removal that was not observed in the control group. Participants exposed to the AI-enhanced curriculum demonstrated significant improvement in safety metrics, such as reducing the rate of healthy tissue removal (mean difference, -7.05 × 10-5 [95% CI, -1.09 × 10-4 to -3.14 × 10-5] mm3 per 20 ms; P < .001) and maintaining a focused bimanual control of the operative field (mean difference in maximum instrument divergence, -4.99 [95% CI, -8.48 to -1.49] mm, P = .006) compared with the control group. However, negative unintended effects were also observed. These included a significantly lower velocity and acceleration in the dominant hand (velocity: mean difference, -0.13 [95% CI, -0.17 to -0.09] mm per 20 ms; P < .001; acceleration: mean difference, -2.25 × 10-2 [95% CI, -3.20 × 10-2 to -1.31 × 10-2] mm per 20 ms2; P < .001) and a significant reduction in the rate of tumor removal (mean difference, -4.85 × 10-5 [95% CI, -7.22 × 10-5 to -2.48 × 10-5] mm3 per 20 ms; P < .001) compared with control. These unintended outcomes diverged students' movement and efficiency performance metrics away from the expertise benchmarks.Conclusions and relevanceIn this cohort study of medical students, an AI-enhanced curriculum for bimanual surgical skills resulted in unintended changes that improved performance in safety but negatively affected some efficiency metrics. Incorporating AI in course design requires ongoing assessment to maintain transparency and foster evidence-based learning objectives.

Project description:BACKGROUND:Non-technical skills (NTS), such as communication and professionalism, contribute to the safe and effective completion of procedures. NTS training has previously been shown to improve surgical performance. Moreover, increases in NTS have been associated with improved clinical endoscopic performance. Despite this evidence, NTS training has not been tested as an intervention in endoscopy. OBJECTIVE:The aim of this study is to evaluate the effectiveness of a simulation-based training (SBT) curriculum of NTS on novice endoscopists' performance of clinical colonoscopy. METHODS:Novice endoscopists were randomized to 2 groups. The control group received 4 hours of interactive didactic sessions on colonoscopy theory and 6 hours of SBT. Hours 5 and 6 of the SBT were integrated scenarios, wherein participants interacted with a standardized patient and nurse, while performing a colonoscopy on the virtual reality (VR) simulator. The NTS (intervention) group received the same teaching sessions but the last hour was focused on NTS teaching. The NTS group also reviewed a checklist of tasks relevant to NTS concepts prior to each integrated scenario case and was provided with dedicated feedback on their NTS performance during the integrated scenario practice. All participants were assessed at baseline, immediately after training, and 4 to 6 weeks post-training. The primary outcome measure is colonoscopy-specific performance in the clinical setting. RESULTS:In total, 42 novice endoscopists completed the study. Data collection and analysis is ongoing. We anticipate completion of all assessments by August 2017. Data analysis, manuscript writing, and subsequent submission for publication is expected to be completed by December 2017. CONCLUSIONS:Results from this study may inform the implementation of NTS training into postgraduate gastrointestinal curricula. NTS curricula may improve attitudes towards patient safety and self-reflection among trainees. Moreover, enhanced NTS may lead to superior clinical performance and outcomes in colonoscopy. TRIAL REGISTRATION:Clinicaltrial.gov NCT02877420; https://www.clinicaltrials.gov/ct2/show/NCT02877420 (Archived by WebCite at http://www.webcitation.org/6rw94ubXX NCT02877420).

Project description:Background and needsMedical educators with simulation fellowship training have a unique skill set. Simulation fellowship graduates have the ability to handle basic and common troubleshooting issues with simulation software, hardware, and equipment setup. Outside of formal training programs such as this, simulation skills are inconsistently taught and organically learned. This is important to address because there are high expectations of medical educators who complete simulation fellowships. To fill the gap, we offer one way of teaching and assessing simulation technical skills within a fellowship curriculum and reflect on lessons learned throughout the process. This report describes the instructional designs, implementation, and program evaluation of an educational intervention: a simulation technology curriculum for simulation fellows.Curriculum designThe current iteration of the simulation technical skill curriculum was introduced in 2018 and took approximately 8 months to develop under the guidance of expert simulation technology specialists, simulation fellowship-trained faculty, and simulation center administrators. Kern's six steps to curriculum development was used as the guiding conceptual framework. The curriculum was categorized into four domains, which emerged from the outcome of a qualitative needs assessment. Instructional sessions occurred on 5 days spanning a 2-week block. The final session concluded with summative testing.Program evaluationFellows were administered summative objective structured exams at three stations. The performance was rated by instructors using station-specific checklists. Scores approached 100% accuracy/completion for all stations.ConclusionsThe development of an evidence-based educational intervention, a simulation technical skill curriculum, was highly regarded by participants and demonstrated effective training of the simulation fellows. This curriculum serves as a template for other simulationists to implement formal training in simulation technical skills.

Project description:BackgroundSimulation-based education can equip healthcare providers with the ability to respond to and manage stressors associated with rapidly deteriorating patient situations. However, little is known about the benefits of using virtual reality (VR) for this purpose.ObjectiveTo compare between desktop VR and face-to-face simulation in stress responses and performance outcomes of a team-based simulation training in managing clinical deterioration.DesignA randomised controlled study METHOD: The study was conducted on 120 medical and nursing students working in interprofessional teams. The teams were randomly assigned to participate in a 2-h simulation using either the desktop VR or face-to-face simulation with simulated patient (SP). Biophysiological stress response, psychological stress, and confidence levels were measured before and after the simulation. Performance outcomes were evaluated after the simulation using a deteriorating patient scenario.ResultsThe systolic blood pressure and psychological stress response were significantly increased among participants in VR and SP groups; however, no significant differences were found between the groups. There was also no significant difference in confidence and performance outcomes between participants in the VR and SP groups for both medical and nursing students. Although the psychological stress response was negatively correlated (r = -0.43; p < 0.01) with confidence levels, there was no association between stress response and performance score.ConclusionDespite being less immersive, the desktop VR was capable of inducing psychological and physiological stress responses by placing emotional, social, and cognitive demands on learners. Additionally, by ensuring close alignment between the simulation tasks and the clinical tasks (i.e. functional fidelity), the desktop VR may provide similar performance outcomes as conventional simulation training. This evidence is timely given the rise in the use of virtual learning platforms to facilitate training during the COVID-19 pandemic where face-to-face training may not be feasible.Trial registrationThe study was registered at ClinicalTrials.gov NCT04330924.

Dataset Information

The effects of active (hot-seat) versus observer roles during simulation-based training on stress levels and non-technical performance: a randomized trial.

Publications

The effects of active (hot-seat) versus observer roles during simulation-based training on stress levels and non-technical performance: a randomized trial.

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