gms | German Medical Science

4th Research in Medical Education (RIME) Symposium 2015

19.03-21.03.2015, München

Simulation-based obstetric anaesthesia training conducted 'in situ' versus 'off site' leads to similar individual and team outcomes; a randomised controlled trial

Meeting Abstract

  • corresponding author presenting/speaker Jette Led Sorensen - University of Copenhagen, Rigshospitalet, Juliane Marie Centre for Children, Women and Reproduction, Copenhagen, Denmark
  • author Cees van der Vleuten - Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Educational Development and Research, Maastricht, Netherlands
  • author Susanne Rosthoej - University of Copenhagen, Faculty of Health Sciences, Institute of Public Health, Section of Biostatistics, Copenhagen, Denmark
  • author Doris Oestergaard - Herlev Hospital, Capital Region of Denmark, Danish Institute for Medical Simulation, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
  • author Vicki LeBlanc - University of Toronto, The Wilson Centre, Toronto, Canada
  • author Marianne Johansen - University of Copenhagen, Rigshospitalet, Juliane Marie Centre for Children, Women and Reproduction, Department of Obstetrics, Copenhagen, Denmark
  • author Kim Ekelund - University of Copenhagen, Rigshospitalet, Juliane Marie Centre for Children, Women and Reproduction, Department of Anaesthesia, Copenhagen, Denmark
  • author Charlotte Krebs Albrechtsen - University of Copenhagen, Rigshospitalet, Juliane Marie Centre for Children, Women and Reproduction, Department of Anaesthesia, Copenhagen, Denmark
  • author Berit Woetmann Pedersen - University of Copenhagen, Rigshospitalet, Juliane Marie Centre for Children, Women and Reproduction, Department of Obstetrics, Copenhagen, Denmark
  • author Bent Ottesen - University of Copenhagen, Rigshospitalet, Juliane Marie Centre for Children, Women and Reproduction, Copenhagen, Denmark

4th Research in Medical Education (RIME) Symposium 2015. München, 19.-21.03.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocRD25

doi: 10.3205/15rime70, urn:nbn:de:0183-15rime708

Veröffentlicht: 12. März 2015

© 2015 Sorensen et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen. Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden. Lizenz-Angaben siehe http://creativecommons.org/licenses/by-nc-nd/3.0/.


Gliederung

Text

Introduction: Obstetric emergencies are rare and simulation-based medical education (SBME) is essential for learning. However, we don’t know how SBME conducted as 'in situ simulations' (ISS) versus (vs.) 'off site simulations' (OSS) impact learning. ISS is believed to increase fidelity, and is hypothesised to be more effective [1]. Research question: What are the effects of ISS vs OSS on individual learning, safety attitude, motivation, stress, team performance and organisational impact?

Methods:

Design: Randomised trial conducted April-June 2013 [2].

Setting: Obstetric and anaesthesia high-risk department, Rigshospitalet, Copenhagen.

Participants: 100 recruited among midwifes, nurses, trainees and consultant doctors from obstetrics and anaesthesiology, anaesthesia and surgical nurses.

Interventions: The same two simulations (management of emergency caesarean section and postpartum haemorrhage) were conducted in teams of ten as either ISS or OSS.

Primary outcome: Multiple choice question test.

Exploratory outcomes: Safety Attitudes Questionnaire, stress inventories as Stait Trait Anxiety Inventory and Cognitive Appraisal, salivary cortisol, Intrinsic Motivation Inventory, questionnaire evaluating perceptions and suggested changes needed in the organization, a team-based score on video-assessed performance.

Results: No differences between the two groups were found for any of the individual or team scores except for the ISS-participants scored the authenticity significantly higher. More ideas for changes on the organisational level were suggested from the ISS-participants.

Discussion: Perceptions of the authenticity differed significantly between ISS and OSS-participants, but it did not affect other individual or team outcome. In non-randomised trials, it is argued that ISS has greater fidelity and thereby expected to increase levels of learning, but this was not confirmed in this trial [1]. The results add to the discussion about dimensions of context and contributions to learning [3]. In this study, the assumption that high fidelity simulations (as ISS) lead to better learning was not supported and this add to recent discussion on fidelity and learning [4], [5].


References

1.
Rosen MA, Hunt EA, Pronovost PJ, Federowicz MA, Weaver SJ. In situ simulation in continuing education for the health care professions: a systematic review. J Contin Educ Health Prof. 2012;32(4):243-254. DOI: 10.1002/chp.21152 Externer Link
2.
Sørensen JL, Van der Vleuten C, Lindschou J, Gluud C, Østergaard D, LeBlanc V, Johansen M, Ekelund K, Albrechtsen CK, Pedersen BW, Kjærgaard H, Weikop W, Ottesen B. "In situ simulation" versus "off site simulation" in obstetric emergencies and their effect on knowledge, safety-attitudes, team performance, stress, and motivation: study protocol for a randomised controlled trial. Trials. 2013;14:220. DOI: 10.1186/1745-6215-14-220 Externer Link
3.
Koens F, Mann KV, Custers EJ, Ten Cate OT. Analysing the concept of context in medical education. Med Educ. 2005;39(12):1243-1249.
4.
Norman G, Dore K, Grierson L. The minimal relationship between simulation fidelity and transfer of learning. Med Educ. 2012;46(7):636–647. DOI: 10.1111/j.1365-2923.2012.04243.x Externer Link
5.
Griersen L. Information processing, specificity of practice, and the transfer of learning: considerations for reconsidering fidelity. Adv Health Sci Educ Theory Pract. 2014;19(2):281-289. DOI: 10.1007/s10459-014-9504-x Externer Link