Abstract
PurposeHigh-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other.MethodsThis study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve.ResultsSelf-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative.ConclusionWith a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.
Highlights
Crisis resource management (CRM) relies on skill sets such as leadership/followership, communication, and resource al-location, which contribute to teamwork for effective patient care during life-threatening emergencies
Each type of debriefing was significantly effective in improving CRM performance (F1,48 = 13.28, P < 0.01), and the degree of effectiveness was similar when comparing self-debriefing and instructor debriefing (F1,48 = 0.31, P < 0.58)
Most point estimates were in the bottom left quadrant, suggesting that self-debriefing was less costly and less effective than instructor-debriefing, whereas a portion of the estimates were in the bottom right quadrant, indicating that self-debriefing was less costly and more effective than instructor debriefing (Fig. 1)
Summary
Crisis resource management (CRM) relies on skill sets such as leadership/followership, communication, and resource al-location, which contribute to teamwork for effective patient care during life-threatening emergencies. High-fidelity simulation training is effective for residents and staff to learn and retain CRM skills [1,2,3,4,5]. 2016, Korea Health Personnel Licensing Examination Institute. The movement of residency training programs design towards competence by design will increase demand for medical simulations within a resource-constrained environment. Due to its human resource intensity, cost is a major barrier to the implementation of high-fidelity simulation training into the curriculum [8,9]. The simulation community usually assumes that a large portion of costs are related to human resources, including faculty time, along with facility and hardware costs [8]. Instructor fees aim to compensate instructors for leave from clinical service and recognize the need for instructors to be trained to effectively and safely debrief learners
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