Evaluation of a simulation-based workshop on clinical performance for emergency physicians and nurses

doi:10.5847/wjem.j.1920-8642.2015.01.003

Abstract

Abstract:

BACKGROUND: Simulation-based medical education has been growing rapidly and becomes one of the most popular teaching methods for improving patient safety and patient care. The Simulation Subcommittee of the Hong Kong College of Emergency Medicine organized an educational program emphasizing the team training, clinical decision-making and communication skills. This study aimed to evaluate the attitude of the participants toward a new training program and the change in the knowledge on clinical performance in emergency physicians and nurses after attending the educational program.
METHODS: A course evaluation form was filled in by the participants at the end of the workshop. An assessment of 20 multiple-choice questions with 5 options was administered to the participants before and after the 2-day simulation-based training workshop.
RESULTS: A total of 72 doctors and nurses working in the Accident and Emergency Department were enrolled. The average pretest and posttest scores were 12 and 14.3 respectively. The percentage improvement in the mean score of the pretest and posttest was 11.5%. The Chi-square test showed significant improvement in the pretest and posttest score grading (P=0.00). Paired t-test revealed significant difference between the mean scores of the pretest and posttest (P=0.00).
CONCLUSIONS: Participants had positive attitude toward this new training program. Significant improvement of the knowledge on clinical performance in healthcare professionals in the Accident and Emergency Department was observed after the participation in this simulation-based educational program.

Key words: Education, Medical, Decision making, Patient care team

Chi Ho Chan, Tung Ning Chan, Man Cheuk Yuen, Wai Kit Tung. Evaluation of a simulation-based workshop on clinical performance for emergency physicians and nurses[J]. World Journal of Emergency Medicine, 2015, 6(1): 16-22.

Figures/Tables 7

Table 1

Multiple choice questions (The options of each question were omitted for simplicity)

Questions
Medical knowledge Which of the following is/are the cause(s) of ventricular fibrillation? Which of the following statement is/are correct concerning the drug therapy for VF/VT? Which of the following is a sign for anticipation of difficult airway during intubation? Which of the following is not the essential treatment for acute severe asthma? Which of the following are feature(s) of acute severe asthma? What is the commonly used Burn Assessment Chart for assessing the extent of burn in a pediatric patient? What is the percentage of a child's palm surface area (excluding fingers) with respect to TBSA (total body surface area) ? In patient with altered mental status, which of the following managements is incorrect? Which one of the following statements is correct about management of increased intracerebral pressure (ICP)? The most commonly injured region in causing neurogenic shock is: In an unconscious and intubated patient, which of the following parameters will give you the earliest reliable indication if that patient develops cardiac arrest? The recommended initial biphasic energy for cardioversion of atrial fibrillation is:
Knowledge on skill performance
Which of the following is the least appropriate action if an intubated patient is noted to have hypoxia? Which of the following regarding endotracheal intubation in suspected C-spine injury is true?
Decision-making
Which of the following statements is false regarding medical decision-making? Which of the following about Dual Process Model of Reasoning is true?
Teamwork and communication skills
The following statements are correct regarding giving a handover or discussing a case except: Which of the following statements are related to graded assertiveness except: In breaking bad news, you should do the following, except: In breaking bad news to relatives of a patient who just passed away, we should provide the following information except:

Table 1

Table 2

Example of case scenario

Scenario	Procedural sedation complications
Objectives	Clinical knowledge To identify and manage the situation of airway and respiratory complications after procedural sedation To take precautions when considering antagonist to reverse the action of benzodiazepam Technical skills To demonstrate airway maneuvers, use of airway adjuncts and bag mask ventilation To show algorithm of difficult airway management Human factors To demonstrate effective teamwork and interaction, effective communication between team members, role clarification and distribution of responsibility among team members
Narrative	The scenario started with a 65-year-old man with a history of epilepsy who had just undergone closed reduction of right shoulder dislocation under procedural sedation. He was transferred to the observation room and found to be drowsy and cyanotic by a nurse.
Expected actions	Timely summons of help and formation of a care team Using airway maneuvers (head tilt, chin lift or jaw thrust) to improve airflow in the upper airway Using airway adjuncts (oropharyngeal or nasopharyngeal airway) to maintain airway patency once an open airway has been established Identifying hypoventilation and hypoxia and performing bag mask ventilation (BMV) Correcting technique of BMV - (a) correctly place a mask via single hand or two hand technique, (b) correction rate - should not exceed 10-12 breath per min, (c) correction volume - just large enough to cause chest rise instead of squeezing explosive) Continuing management of respiratory depression - Continue good quality bag mask ventilation and consideration of intubation for airway protection Using alternative method(s) to ventilate the patient (e.g LMA) when endotracheal tube intubation failed in patient with hypoventilation Avoidance of flumazenil as an antagonist for the action of benzodiazepam as it might provoke seizure in an epileptic patient

Table 2

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Table 6

Table 7

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Ranking	Number of participants
Associate consultant	9
Resident	17
Ward manager	1
Nursing officer	1
Advanced practicing nurse	18
Registered nurse	26
Total	72

Marks	Grade	Pretest (n, %)	Posttest (n, %)
90% or above	A	1 (1.4)	11 (15.3)
75%-89%	B	11 (15.3)	24 (33.3)
50%-74%	C	45 (62.5)	34 (47.2)
<50%	D	15 (20.8)	3 (4.2)
Total		72 (100)	72 (100)

Pretest grades	Number of participants (n, %)	Posttest grades (n, %)
Pretest grades	Number of participants (n, %)	A	B	C	D	Total
A	1 (1.4)	1 (100)	0	0	0	1 (1.4)
B	11 (15.3)	7 (63.6)	4 (36.4)	0	0	11 (15.3)
C	45 (62.5)	3 (6.7)	19 (42.2)	23 (51.1)	0	45 (62.5)
D	15 (20.8)	0	1 (6.7)	11 (73.3)	3 (20)	15 (20.8)
Total	72 (100)	11 (15.3)	24 (33.3)	34 (47.2)	3 (4.2)	72 (100)

Variables	Range (0-5)	Mean (0-5)	Median	Quartile
Variables	Range (0-5)	Mean (0-5)	Median	1 st	3 rd
The couse is appropirate for my level of learning	3-5	4.3	4	4	5
I plan to apply what I learnt here to my practice	3-5	4.3	4	4	5
The simulation scenarios are realistic	3-5	4.3	4	4	5
The simluation scenarios are challenging	3-5	4.3	4	4	5
Compared with non-simulation training, simulation-based training is more appropriate for me	3-5	4.3	4	4	5
Simulation based training has improved my confidence	3-5	4.2	4	4	5
The interactive lecture on teamwork meets my learning needs	3-5	4.2	4	4	5
The interactive lecture on decision-making meets my learning needs	3-5	4.2	4	4	5
The interactive lecture on communication skills for difficult situations meets my learning needs	2-5	4.2	4	4	5
The lectures are relevant to my work in real life	3-5	4.3	4	4	5
The pre-course materials are helpful	2-5	3.7	4	3	4
The debriefing experience allows me to see my mistakes	3-5	4.4	4	4	5
I would recommend this workshop to my colleagues	4-5	4.6	5	4	5
Overall course rating	3-5	4.4	4	4	5

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