Ageing and Acute Care Physicians' Performance

Study Overview
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Brief Summary
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The proportion of older acute care physicians (ACPs) has been increasing. Ageing is associated with physiological changes and research investigating how such age-related physiological changes affect clinical performance is lacking. Specifically, Crisis Resource Management (CRM) consists of essential clinical skills in acute care specialties which when absent, can significantly impact patient safety. As such, the goals of this study are to investigate whether ageing has a correlation with baseline CRM skills of ACPs and whether ageing influences learning from high fidelity simulation.

Detailed Description
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The proportion of older acute care physicians (ACP), emergency, critical care & anesthesia, has been steadily increasing. Ageing is associated with physiological changes, which in turn can influence a physician's clinical abilities and decision-making. The litigation and physician disciplinary data suggests that incidents involving all physicians are likely to occur later in practice, with degree of injury identified in the claims being of greater severity. However research, investigating how age-related physiological changes affect clinical performance and patient safety, is lacking. CRM skills are essential skills within acute care specialties, and are vital for patient safety. CRM encompasses technical skills, as well as a rapid and organized approach to non-technical, cognitive skills such as decision-making, task management, situational awareness and team management. High-fidelity full body mannequin simulation-based education is effective for learning CRM, including transfer of skills from the simulated setting to the clinical setting and improving patient outcome. However, there is a gap in the literature on whether physicians' age influences baseline CRM performance and also learning from simulation-based education. Although the effectiveness of high-fidelity simulation-based education has been studied extensively in junior learner populations (students, residents, fellows), there are a limited number of studies investigating its effectiveness in teaching CRM in the ageing physician population. In fact, a recent systematic review looking at the role of simulation in continuing medical education (CME) in ACPs supported that there is limited evidence supporting improved learning. Despite not knowing whether simulation is the correct tool in an ageing population, it is being recommended as a training, regulation and assessment tool for practicing physicians. Objectives: The goals of this study are to: Investigate whether ageing has a correlation with baseline CRM skills of ACPs using simulated crisis scenarios and Assess whether ageing influences learning from high fidelity simulation.

Official Title
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Impact of Acute Care Physician's Age on Crisis Management Performance and Learning After Simulation-based Education

Conditions
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Ageing

Intervention / Treatment
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* Other: CRM Simulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Emergency physicians Critical care physicians Anesthesiologists minimum 5 years of practice post-residency Exclusion Criteria: Post-call day of participation
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CRM Simulation<br>Each participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test. | Other: CRM Simulation<br>* Each participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CRM Performance during first sim scenario assessed by Ottawa Global Rating Scale (GRS) | Ottawa GRS score will be correlated with age | After managing first simulation scenario - Day 1 | 
| CRM Performance during first sim scenario assessed by ACLS checklist | ACLS score will be correlated with age | After managing first simulation scenario - Day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Learning from high-fidelity simulation education assessed by Ottawa Global Rating Scale | Ottawa GRS score will be compared to score in first scenario to look for improvement | After managing second simulation scenario - Day 1 | 
| Learning from high-fidelity simulation education assessed by ACLS checklist | ACLS score will be compared to score in first scenario to look for improvement | After managing second simulation scenario - Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Simulation, Continuing Medical Education, Non-technical Skills, Crisis Resource Management