title: A multinational randomised study comparing didactic lectures with case scenario in a severe sepsis medical simulation course.
abstract: BACKGROUND
  Medical simulation has been used to teach critical illness in a variety of settings. This study examined the effect of didactic lectures compared with simulated case scenario in a medical simulation course on the early management of severe sepsis.
  
  
  METHODS
  A prospective multicentre randomised study was performed enrolling resident physicians in emergency medicine from four hospitals in Asia. Participants were randomly assigned to a course that included didactic lectures followed by a skills workshop and simulated case scenario (lecture-first) or to a course that included a skills workshop and simulated case scenario followed by didactic lectures (simulation-first). A pre-test was given to the participants at the beginning of the course, post-test 1 was given after the didactic lectures or simulated case scenario depending on the study group assignment, then a final post-test 2 was given at the end of the course. Performance on the simulated case scenario was evaluated with a performance task checklist.
  
  
  RESULTS
  98 participants were enrolled in the study. Post-test 2 scores were significantly higher than pre-test scores in all participants (80.8 ± 12.0% vs 65.4 ± 12.2%, p<0.01). There was no difference in pre-test scores between the two study groups. The lecture-first group had significantly higher post-test 1 scores than the simulation-first group (78.8 ± 10.6% vs 71.6 ± 12.6%, p<0.01). There was no difference in post-test 2 scores between the two groups. The simulated case scenario task performance completion was 90.8% (95% CI 86.6% to 95.0%) in the lecture-first group compared with 83.8% (95% CI 79.5% to 88.1%) in the simulation-first group (p=0.02).
  
  
  CONCLUSIONS
  A medical simulation course can improve resident physician knowledge in the early management of severe sepsis. Such a course should include a comprehensive curriculum that includes didactic lectures followed by simulation experience.
authors.affiliation: Department of Emergency Medicine, Chang-Gung Memorial Hospital, Keelung Branch, Keelung City, Taiwan.
authors.forename: Chih-Huang
authors.initials: CH
authors.lastname: Li
authors.forename: Win-Sen
authors.initials: WS
authors.lastname: Kuan
authors.forename: Malcolm
authors.initials: M
authors.lastname: Mahadevan
authors.forename: Lynda
authors.initials: L
authors.lastname: Daniel-Underwood
authors.forename: Te-Fa
authors.initials: TF
authors.lastname: Chiu
authors.forename: H Bryant
authors.initials: HB
authors.lastname: Nguyen
mesh_terms: D001208:Asia; D003479:Curriculum; D004502:Education, Medical, Continuing / Q000379:methods*; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D011446:Prospective Studies; D018805:Sepsis / Q000628:therapy*; D013663:Teaching / Q000379:methods*