Mindfulness and Executive Functions for Prediction of Non-technical Skills of Students in Pediatric Medical Simulations
Condition: Mindfulness
Study type: Observational

Summary: 
      Medical simulation is a technique that creates a situation or environment to allow persons to
      experience a representation of a real event for the purpose of practice, learning,
      evaluation, testing or to gain understanding of systems or human actions Non-technical skills
      in pediatric simulation are the skills of communication, leadership, teamwork, situational
      awareness, decision-making, resource management, safe practice, adverse event minimization,
      and professionalism, also known as teamwork skills. Mindfulness is the self-regulation of
      attention with an attitude of curiosity, openness and acceptance. Executive functions include
      a collection of interrelated functions that are responsible for purposeful, goal-directed,
      problem-solving behavior. In this project, the investigators aim to check whether features of
      mindfulness and executive functions can be used to predict teamwork skills of medical
      students during repeated high-fidelity simulations in emergency pediatric care.

      The project will include simulation center in Bialystok, Poland. The investigators will
      conduct this project over a time of 2 years. Team project is made up of 5 persons, including
      psychologist, simulation instructors and pediatricians. Participants will be students of
      medical faculty in medical university. The investigators expect to include at least 340
      students in the study which will result in 180 assessed as main or second leaders in repeated
      simulations. Team project will assess the students during high-fidelity pediatric emergency
      simulations.

      Methods of assessment of medical students during pediatric emergency simulations: features of
      mindfulness (Mindful Attention Awareness Scale), assessment of executive functions (The
      Behavior Rating Inventory of Executive Functions - Adult), non-technical skills (Ottawa
      Crisis Resource Management scale & checklist), technical skills (checklists) and stress. The
      researchers first will examine association between mindfulness or executive functions and
      demographic variables. And finally team project will assess the possibility of prediction of
      non-technical performance level during medical simulations with the use of mindfulness and
      executive functions assessment.

      In general the investigators anticipate that the results of the study will lead to the better
      understanding of mechanisms that influence non-technical skills in medical students during
      pediatric emergency cases.
    

Detailed description: 
      Research Project Objectives / Research Hypothesis High-fidelity simulation is an effective
      tool in creating psychological reality of pediatric emergency care. Non-technical skills play
      a pivotal role in management of life-threatening cases in children. Mindfulness is the
      self-regulation of attention with an attitude of curiosity, openness and acceptance. It is
      possible that mindfulness could enhance medical students' capacity for focused attention and
      concentration by increasing present moment awareness. On the other hand executive functions
      include a collection of interrelated functions that are responsible for purposeful,
      goal-directed, problem-solving behavior. It is likely that mindfulness and executive
      functions and their relationship are important players in emergency cases. Repeated
      simulations could be a crucial tool for stress management and improving skills in
      high-fidelity scenarios. In this project, the investigators aim to define whether features of
      mindfulness and executive functions can be used to predict non-technical skills of medical
      students during repeated high-fidelity simulations in emergency pediatric care. The
      researchers hypothesize that: 1) being mindful improves the performance during simulation 2)
      better executive functions result in better non-technical skills of medical student 3)
      repeated simulations will reduce stress and influence performance during scenarios 4) there
      are some potential correlations between executive functions and mindfulness 5) it is possible
      to predict non-technical performance with the assessment of mindfulness and executive
      functions of students during pediatric emergency cases.

      Research project methodology This is a multi-center, investigator-initiated prospective
      study. The project will include simulation center in Poland (Medical University in
      Białystok). The researchers will conduct this project over a time of 2 years. Team project is
      made up of 5 persons, including psychologist, simulation instructors and pediatricians.
      Participants will be students of medical faculty in medical university. Methods: First, to
      increase the awareness of scientific community of the area of interest, the scientists will
      prepare and publish the review of the current literature in the field of mindfulness,
      executive functions and emergency medicine. Then, the researchers will adapt six
      high-fidelity scenarios in the field of pediatric emergency for the requirements of the
      project. The team project expect to include at least 340 students in the study which will
      result in 180 assessed as main or second leaders in repeated simulations. For the
      accomplishment of the aims of this study researchers will need: high-fidelity simulation
      rooms = emergency rooms with full medical equipment, high-fidelity simulators, audio-video
      systems for recording and playing scenarios, ECG Holters, debriefing rooms, computers and
      software. All above mentioned equipment is available in simulation centers and the
      investigators have the professional staff experienced in high-fidelity simulation and
      assessment of non-technical skills in medical students. Demographic features will be assessed
      in all participants: age, sex, year of medical faculty, medical school. The history of
      previous high-fidelity simulations in participating students will be collected. Methods of
      assessment of medical students during pediatric emergency simulations: features of
      mindfulness (Mindful Attention Awareness Scale), assessment of executive functions (The
      Behavior Rating Inventory of Executive Functions - Adult), non-technical skills (Ottawa
      Crisis Resource Management scale & checklist), technical skills (checklists) and stress
      (heart rate, heart rate variability with Holter ECG, blood pressure, Stress-O-Meter and the
      State-Trait-Anxiety Inventory). Data analysis strategy: The study team will first examine
      association between mindfulness or executive functions and demographic variables (gender,
      age, university). Then the researchers are going to construct the regression model to explain
      the variability of features included in Ottawa scale. And finally the study team will assess
      the possibility of prediction of non-technical performance level during medical simulations
      with the use of mindfulness and executive functions assessment.

      Expected impact of the research project on the development of science To date more than 150
      students were enrolled for the preliminary research. The preliminary results showed that: in
      the first simulation the students' non-technical performance is weak, one of the main
      problems in non-technical skills is the fixation error and it is more frequent in simulations
      with two cases at one time, in the repeated simulations non-technical skills are improving,
      there is a growing interest in mindfulness training among medical students, technical skills
      depend of theoretical introduction and students' preparation for the classes, concerning
      stress the statistically significant increase in heart rate but not blood pressure in
      students after each simulation was observed . These data clearly show that the proposed study
      concept is a promising line of basic investigation with solid potential for defining a
      predictive link between mindfulness, executive function and non-technical skills of medical
      students during pediatric emergency simulations. In general the investigators anticipate that
      the results of the present study will lead to the better understanding of mechanisms that
      influence non-technical skills in medical students during pediatric emergency cases. In the
      future this research will be used for an overall improvement in team performance at emergency
      events, which will ultimately translate into a subsequent reduction in the rate of errors and
      adverse events in medicine. The team leaders also hope that an increased awareness of
      non-technical skills in the emergency setting among medical students will have an indirect
      beneficial effect on those skills in the day-to-day setting.

      The scientific results of the project will include: review manuscript and at least two
      original manuscripts, all published in Journals with Impact Factor ≥ 3, presentations on two
      international meetings in Europe.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Students of medical faculty (6th year) at the Medical University of Bialystok
      
Keywords: mindfulness; executive functions; medical simulation; medical students; pediatrics