Comparison of three simulation-based training methods for managing medical emergencies.

Abstract

Trainee medical officers (TMOs) participated in a study comparing 3 methods of simulation-based training to treat medical emergencies occurring in a hospital setting. The methods were: Group 1: Computer screen-based training (CSBT), scripted presentations on medical emergencies and practice on simple part-task trainers, Group 2: As above but with practice on whole-body patient simulators, Group 3: As above plus practice using patient simulators in ‘full-mission’ simulation. All groups had the same total teaching time. Participants (n=64) had an initial (pre-training) assessment by written tests, self assessment and simulations of medical emergencies (‘VT’ and ‘HYPOglycaemia’). Participants were tested again post-training using similar simulations to the initial scenario and a new scenario (‘ANAphylaxis’). Trained ‘experts’, blinded to the teaching group of participants, watched video-CDs of the simulations to assess trainees’ performance. All groups demonstrated increased knowledge and confidence (pre-training scores compared to post-) but no differences could be detected between the three groups. In simulated emergencies, post-training scores were also improved. There was no difference between groups in the ‘HYPO’ scenario but moderate evidence in the ‘VT’ scenario that Group 3 was superior. In the ‘ANA’ scenario, Group 3 had far better test scores, especially in behavioural items. There did not appear to be any significant advantage of using whole body manikins over CSBT and simple part-task trainers but full-mission simulation training developed the ability to recognise when skills learnt to manage one medical emergency can be useful in another not previously encountered. This provides support for investment in simulation training.