Crisis Resource Management Improvement Through Intellectual Questioning of Authority

Study Overview
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Brief Summary
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This is a randomized controlled trial examining the effectiveness of a teaching intervention on residents' and medical students' ability to challenge clearly wrong decisions by a superior during a simulated life-threatening crisis. Participants will be randomly allocated into the control or intervention arm. The intervention arm will receive education on crisis resource management (CRM) and teaching targeting the cognitive skills required to monitor and challenge a superior's decision, and conflict resolution tools. Participants will then take part in a simulation scenario 2 to 4 weeks later and will be assessed based on 6 challenge points, followed by a debrief session.

Official Title
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Crisis Resource Management Improvement Through Intellectual Questioning of Authority

Conditions
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Medical Education, Simulation, Crisis Resource Management

Intervention / Treatment
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* Other: Crisis Resource Management Skill Training
* Other: Standard ACLS Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Medical officers or Internal medicine, surgical and emergency medicine residents who are in their 2nd post-graduate year of training, or Phase V medical students from Yong Loo Lin School of Medicine, National University of Singapore Exclusion Criteria: Refusal for informed consent, or Refusal for video recording during simulation sessions

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Control<br>Subjects allocated to the control arm will receive standard didactic interactive session on Advanced Cardiac Life Support (ACLS) principles, as part of their regular teaching schedule. | Other: Standard ACLS Training<br>* Standard didactic interactive session on Advanced Cardiac Life Support (ACLS) principles.<br>|
| Experimental: Intervention<br>Subjects allocated to the intervention arm will receive education on crisis resource management (CRM) and teaching targeting the cognitive skills required to monitor and challenge a superior's decision, and conflict resolution tools, in addition to standard didactic interactive session on Advanced Cardiac Life Support (ACLS) principles. | Other: Crisis Resource Management Skill Training<br>* Focused crisis resource management training which targets at the cognitive skills needed to monitor and challenge a superior's decision.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effect of a teaching intervention on participants' ability to challenge clearly wrong decisions by a superior during a simulated life-threatening crisis | Comparison of the best modified Advocacy-Inquiry Score (mAIS) responses of the 6 challenge opportunities between the intervention and control groups. The mAIS is a modification of the Advocacy-Inquiry method which includes five scoring levels with the addition of a sixth level when a trainee attempts to take over management of the case. | 20 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Influence of the confederate's gender on participant's ability to challenge incorrect decisions | Comparison of the median modified Advocacy-Inquiry Score (mAIS) responses between the subjects exposed to male versus female confederate specialist. The mAIS is a modification of the Advocacy-Inquiry method which includes five scoring levels with the addition of a sixth level when a trainee attempts to take over management of the case. | 20 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Medical Education, Simulation, Crisis Resource Management