Using scripts to improve the state-wide delivery of simulated resuscitation education

INTERVENTION: Multi‐centre cluster randomised control trial of scripts versus no scripts for the quality of debrief of medical simulation within a paediatric resuscitation course. The Recognition and Management of the Deteriorating Paediatric Patient (RMDPP) is a resuscitation course currently delivered at 30 sites in all 16 Hospital and Health Service districts of Queensland, the most decentralised state in Australia. Resuscitation skills are contextualised into 2 simulated scenarios using medical manikins, which run for about 10 minutes. These scenarios are immediately debriefed, which entails staff sitting down with participants and discussing the scenario to make sense of what occurred, what went well and what could be improved upon. Many of the staff at regional sites have limited or no previous experience in debriefing simulated scenarios, which can impact on how effectively they meet the participants’ learning objectives. Each site is supported by staff from Children's Health Queensland, who undertake 2 annual visits. Feedback is provided for debriefing the scenarios in the form of a tool, which has been proven to be objective and reliable.[1] This study specifically looks at whether the addition of a script for debriefing at each of the sites improves the score on the feedback tool for each debrief. The overall goal being to provide consistent training in paediatric resuscitation throughout Queensland to better patient outcomes, particularly in rural and remote locations, where resources are limited. Intervention The concept of the debriefing scripts was adapted from the ExPRESS trial and based on the debriefing theory known as “advocacy‐inquiry”.[2‐4] Our scripts were constructed from each of the scenario’s learning objectives, with a mixture of both crisis resource management and technical issues, which reflect the course skills stations. The scripts are delivered by the faculty at each RMDPP site across Queensland that are randomised to the intervention arm. The duration of the scripted debriefing is around 10 minutes, as per a standard debrief. Blinding Blinding is an issue given the potential pattern recognition amongst assessors and is likely to be a limitation of this study. However, it is also probable that experienced debriefers will not stick to the script and may perform debriefs that are harder to recognise. It was noted that in the ExPRESS trial all debriefers held a clipboard that was purported to allow for blinding of the video reviewers to non‐scripted versus scripted debriefing, but there was no mention in the study of its effectiveness.[2] This could be replicated in our study but may not mitigate this bias. As this will be a real‐world trial, adherence to the script will not be scrutinised. As a multi‐centre randomised controlled trial, sites currently delivering the RMDPP program will be clustered where SToRK staff routinely work, stratified into large and small centres and then randomised into intervention and control groups. Consent will be obtained to video all debriefs undertaken at moderation visits and have these videos scored using the OSAD tool by a common blinded assessor in a physically and temporally removed setting.[1] We will assess the between‐arm difference using a mixed– effects linear regression, with treatment arm included as a fixed effect and site as a random effect. This method will account for any within‐site correlation in debrief outcomes. We will conduct pre‐specified subgroup analyses to account for centre size and faculty debriefing experience. References: [1] Arora S, et al. Objective Structured Assessment of Debriefing (OSAD): Bringing science to the art of debriefing in surgery. Annals of Surgery. 2012. 256(6):982‐988. [2] Cheng A et al. Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing. A Multicenter Randomized Trial. JAMA Pediatr. 2013; 167(6):528‐536. [3] Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB. Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiol Clin. 2007;25(2):361‐376. [4] Rudolph JW, Simon R, Dufresne RL, Raemer DB. There’s no such thing as “non‐ judgmental” debriefing: a theory and method for debriefing with good judgment. Simul Healthc. 2006;1(1):49‐55. CONDITION: Medical education and training Medical simulation Paediatric resuscitation Recognition and management of the deteriorating child PRIMARY OUTCOME: OSAD score: Objective Structured Assessment of Debriefing SECONDARY OUTCOME: Verification of OSAD score by an independent reviewer of videoed debrief INCLUSION CRITERIA: All faculty involved in debriefing the course scenarios at each site will be eligible, regardless of previous experience. All course participants at each site will be eligible to receive the debriefing. Sites were sorted into large and small centres and then randomised to intervention or control. Large centres will be defined by service to a population equal or greater than 100,000 and small centres will be defined by service to a population less than 100,000.