[Country] / Healthcare population and sample size / Clinical context / Study design
Mannequin type / Learning intervention
Time to assessment / Assessment of behaviour at workplace / Results
Conclusion
Shapiro et al.
(2004)
[United States] / 4 teams; each team consists of 1 MD, 1 resident, 3 RNs / Emergency Medicine / RCT – teams randomized to simulation-enhanced CRM teaching or no extra teaching. Outcomes during real trauma activations were compared
Did not mention the mannequin / Both teams received training on ‘Emergency Team Coordination’.
Simulation group received additional 8 hour simulation training with debriefing.
Didactic group worked in the ED for one 8 hour shift in their respective groups
Up to five weeks post-intervention / Teamwork observation and rating in their normal ED rotations were performed at baseline pre-training and post-training for both groups of teams.Each team was observed twice in each phase.
The ‘Behavioural Anchored Rating Scale’ (BARS) was used to assess behaviour at workplace within two weeks post-intervention / Simulation group showed a non-significant improvement in the quality of team behaviour (p = 0.07);
Control group showed no change in team behaviour during the two observation periods (p = 0.55)
Simulation appears to be promising to improve CRM team behaviours
Knudson et al.
(2008)
[United States] / 18 surgical residents / Trauma / RCT–subjects randomized to scenario-based didactic sessions or scenario-based, simulator-enhanced teaching. Outcomes during real trauma activationswere compared
Simman® (Laerdal®) / Both teaching formats included viewing videotaped examples of “good” and “bad” emergency department trauma resuscitations.
In the lecture group, the scenario and teaching points were presented on slides (1 hour each session).
In the simulation group, the team acted out the scenario(20 minutes on average) (5 scenarios) followed by debriefing
No fixed time frame (first four resuscitations performed) / Technical and non-technical skills were assessed.
A non-validated self-developed assessment tool was used on the first four real trauma for each subject / The simulation group performed better than the didactic group at behavioural skills level (increased performance by around 9%) but no difference at technical skills level
Simulation may be more effective than didactic teaching for transfer of learning of CRM skills
Bruppacheret al.
(2010)
[Canada] / 20 anesthesiapost-graduate trainees / Anesthesia - weaning from cardiopul-monary bypass / RCT–subjects randomized to simulation teaching or didactic teaching.
Outcomesduring weaning from cardiopulmonary bypassin the operating room.
Simman® (Laerdal®) / Both groups received some didactic teaching;
Simulation-based Training: each trainee attended an individual simulation training for a 2-h session (4scenarios), including debriefing
Interactive Seminar: Each trainee attended an individual 2-h interactive training, seminar included audio-visual aids of four paper-based scenarios similar to those described for simulation training seminar
Up to five weeks post-intervention / ‘Anaesthesiologist’s Nontechnical Skills Global Rating Scale’ (ANTS)and Checklist on three successive patients per subject: one at before the intervention, one two weeks after and one five weeks later (retention test). / The simulation group scored significantly higher than the seminar group at both post-test (Global Rating Scale:p<0.001; checklist: p<0.001) and retention test (Global Rating Scale:p<0.001; checklist: p<0.001)
High-fidelity simulation-based training leads to improved patient care during cardiopulmonary bypass weaning when compared with interactive seminars
Miller et al.
(2012)
[United States] / 39 trauma activations involving staff MDs and residents, RNs, technician, pharmacists, clerks, and RTs in an ED / Trauma / ITS - teamwork behaviors were observed during real trauma activations and compared over four periods: pre test (baseline, didactic-based phase) and post test (simulation and decay phase)
Simman® (Laerdal®) / 1) pre-intervention phase (scoring trauma
activations before any interventions), 2) didactic-only phase, 3) in situ trauma simulation (ISTS) phase (8 simulation sessions), 4) decay phase, up to 4week following the end of the ISTSs
Up to five weeks post-intervention / Validated ‘clinical teamwork scale’ (CTS)measured teamwork on 39 actual trauma during the study / CTS measurements for teamwork improved in 12 out of 14 domains during ISTS phase compared to baseline, whereas only 1 CTS improved during the didactic phase. All CTS measures returned to baseline during the decay phase
Teamwork and communication in the clinical setting may be improved during an in situ simulation program, but these potential benefits are lost if the simulation program is not continued
CRM = crisis resource management; ED = emergency department; ITS = interrupted time series; MD = medical doctor; RCT = randomized controlled trial; RN = registered nurse; LOS = length of stay.