title: Short simulation training improves objective skills in established advanced practitioners managing emergencies on the ward and surgical intensive care unit.
abstract: BACKGROUND
  Several studies evaluating simulation training in intensive care unit (ICU) physicians have demonstrated improvement in leadership and management skills. No study to date has evaluated whether such training is useful in established ICU advanced practitioners (APs). We hypothesized that human patient simulator-based training would improve surgical ICU APs' skills at managing medical crises.
  
  
  METHODS
  After institutional review board approval, 12 APs completed ½ day of simulation training on the SimMan, Laerdal system. Each subject participated in five scenarios, first as team leader (pretraining scenario), then as observer for three scenarios, and finally, again as team leader (posttraining). Faculty teaching accompanied each scenario and preceded a debriefing session with video replay. Three experts scored emergency care skills (Airway-Breathing-Circulation [ABCs] sequence, recognition of shock, pneumothorax, etc.) and teamwork leadership/interpersonal skills. A multiple choice question examination and training effectiveness questionnaire were completed before and after training. Fellows underwent the same curriculum and served to validate the study. Pre- and postscores were compared using the Wilcoxon signed rank test with two-tailed significance of 0.05.
  
  
  RESULTS
  Improvement was seen in participants' scores combining all parameters (73% ± 13% vs. 80% ± 11%, p = 0.018). AP leadership/interpersonal skills (+12%), multiple choice question examination (+4%), and training effectiveness questionnaire (+6%) scores improved significantly (p < 0.05). Fellows teamwork leadership/interpersonal skills scores were higher than APs (p < 0.001) but training brought AP scores to fellow levels. Interrater reliability was high (r = 0.77, 95% confidence interval 0.71-0.82; p < 0.001).
  
  
  CONCLUSIONS
  Human patient simulator training in established surgical ICU APs improves leadership, teamwork, and self-confidence skills in managing medical emergencies. Such a validated curriculum may be useful as an AP continuing education resource.
authors.affiliation: Division of Traumatology, Surgical Critical Care & Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. jose.pascual@uphs.upenn.edu
authors.forename: Jose L
authors.initials: JL
authors.lastname: Pascual
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.forename: Michael A
authors.initials: MA
authors.lastname: Vella
authors.forename: Joseph
authors.initials: J
authors.lastname: Palmieri
authors.forename: Corinna
authors.initials: C
authors.lastname: Sicoutris
authors.forename: Ben
authors.initials: B
authors.lastname: Selvan
authors.forename: Adam D
authors.initials: AD
authors.lastname: Fox
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Carrie
authors.initials: C
authors.lastname: Sims
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.forename: Charles William
authors.initials: CW
authors.lastname: Schwab
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009722:Nurse Practitioners; D016544:Patient Simulation; D010362:Patients' Rooms; D010823:Physician Assistants; D013663:Teaching / Q000379:methods; D000078329:Workforce