Exploring Self-regulatory Processes in Anesthesiologists During Massive Transfusion

Study Overview
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Brief Summary
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The purpose of the project is to investigate the function of self-regulatory processes in anesthesiologists and how application of these processes influence performance in a crisis situation.The investigators intend to explore specifically the first phase of self-regulation, i.e. the forethought phase which describes processes related to strategic planning, goal setting, goal orientation, and outcome expectation. The investigators hypothesize that prompting forethought before engaging in a simulated massive transfusion crisis situation will result in better task performance in anesthesiologists.

Detailed Description
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The investigators will conduct 3 studies building on each other. Pilot Study: the purpose of this study is to develop measurement tools for forethought, performance and a tool for prompting forethought. This study will include 2 attending anesthesiologists and 2 anesthesia residents (PGY2, 5). Study I: the purpose of this study is to validate the measurement tools for forethought, performance and the tool for prompting forethought. This will include 6 attending anesthesiologists, 6 PGY5 and 6 PGY2 anesthesia residents. Study II: the purpose of this study is to investigate if prompting forethought in anesthesia residents will result in better performance in a simulated massive transfusion than no prompting.

Official Title
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Optimizing Intra-Operative Massive Transfusion: Probing for Forethought

Conditions
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Forethought, Performance, Self-regulation

Intervention / Treatment
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* Other: Prompting forethought


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pilot study: attending anesthesiologists at St. Michael's Hospital , PGY5, PGY2 anesthesia residents at University of Toronto Study I: attending anesthesiologists at St. Michael's Hospital, PGY5, PGY2 anesthesia residents at University of Toronto Study II: PGY2, PGY3, PGY4 anesthesia residents at University of Toronto Exclusion Criteria: Refusal to take part in the study
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

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Prompting forethought<br>A demographic questionnaire will be filled out by each participant. After randomization, participants will be presented with the background information of the simulated scenario.Subsequently: participants forethought will be prompted and each participant will be asked to report his/her forethought, participants then will be asked to manage a simulated massive transfusion scenario, at completion of the scenario, each participant will undergo individualized debriefing and a syllabus on massive transfusion will be briefly discussed with them and also provided as a reading material for learning. | Other: Prompting forethought<br>* Participants will be asked questions which elicit specific forethought elements related to the given clinical situation. These are elements that relate to strategic planning, goal setting, goal orientation, imagery, outcome expectation. These context specific questions will be determined in the Pilot study and validated in Study I.<br>|
| No Intervention: No prompting<br>A demographic questionnaire will be filled out by each participants. After randomization, participants will be presented with the background information of the simulated scenario.Subsequently: participants will sit and wait for a predetermined time before entering into the simulator, participants then will be asked to manage a simulated massive transfusion scenario, at completion of the scenario, each participant will be interviewed about their thought process before entering to the simulation room, each participant will undergo individualized debriefing and a syllabus on massive transfusion will be briefly discussed with them and also provided as a reading material for learning. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Performance in managing simulated massive transfusion scenario | Task specific performance tool will be developed in the Pilot study and will be validated in Study I. Each performance will be video recorded and two independent, blinded rater will evaluate the videos and assess performance. Performance assessment tool will be numerical including a 1-5 point scale for each performance element and a Global Rating Scale. Difference between massive transfusion management performance will be compared in anesthesia residents whose forethought is prompted to residents who don't receive prompting. | Each individual's performance will be video recorded and subsequently evaluated within 8 weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between forethought scores and performance scores. | The investigators will determine if quality of forethought relates to quality of performance in anesthesia residents managing the simulated massive transfusion scenario. The Pilot study and Study I will be used to develop and validate a scoring form for forethought. This will include scores (1-5) for each forethought elements (strategic planning, goal setting, goal orientation, imaginary, outcome expectation) and a GRS (1-5). | Forethought scores and performance scores will be determined within 8 weeks after individuals participated in the study. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Massive transfusion protocols, Self-regulatory learning, Forethought, Clinical expertise, Simulation, Education