title: Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial.
abstract: OBJECTIVE
  Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings.
  
  
  OBJECTIVE
  To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. DESIGN Prospective, randomized, factorial study design.
  
  
  METHODS
  The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing.
  
  
  METHODS
  We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. INTERVENTION Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators.
  
  
  METHODS
  Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC).
  
  
  RESULTS
  There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes.
  
  
  CONCLUSIONS
  The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.
authors.affiliation: University of Calgary, Calgary, Canada. adam.cheng@albertahealthservices.ca
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.forename: Aaron
authors.initials: A
authors.lastname: Donoghue
authors.forename: Kristen
authors.initials: K
authors.lastname: Nelson-McMillan
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Judy
authors.initials: J
authors.lastname: Leflore
authors.forename: Walter
authors.initials: W
authors.lastname: Eppich
authors.forename: Mike
authors.initials: M
authors.lastname: Moyer
authors.forename: Marisa
authors.initials: M
authors.lastname: Brett-Fleegler
authors.forename: Monica
authors.initials: M
authors.lastname: Kleinman
authors.forename: Jodee
authors.initials: J
authors.lastname: Anderson
authors.forename: Mark
authors.initials: M
authors.lastname: Adler
authors.forename: Matthew
authors.initials: M
authors.lastname: Braga
authors.forename: Susanne
authors.initials: S
authors.lastname: Kost
authors.forename: Glenn
authors.initials: G
authors.lastname: Stryjewski
authors.forename: Steve
authors.initials: S
authors.lastname: Min
authors.forename: John
authors.initials: J
authors.lastname: Podraza
authors.forename: Joseph
authors.initials: J
authors.lastname: Lopreiato
authors.forename: Melinda Fiedor
authors.initials: MF
authors.lastname: Hamilton
authors.forename: Kimberly
authors.initials: K
authors.lastname: Stone
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reid
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hopkins
authors.forename: Jennifer
authors.initials: J
authors.lastname: Manos
authors.forename: Jonathan
authors.initials: J
authors.lastname: Duff
authors.forename: Matthew
authors.initials: M
authors.lastname: Richard
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence; D004311:Double-Blind Method; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007223:Infant; D008348:Manikins; D010348:Patient Care Team; D011446:Prospective Studies; D013663:Teaching / Q000379:methods*; D014741:Video Recording