Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review

A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues

Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.

Evaluating Reproducibility and Transparency in Emergency Medicine Publications

INTRODUCTION

We aimed to assess the reproducibility of empirical research by determining the availability of components required for replication of a study, including materials, raw data, analysis scripts, protocols, and preregistration.

METHODS

We used the National Library of Medicine catalog to identify MEDLINE-indexed emergency medicine (EM) journals. Thirty journals met the inclusion criteria. From January 1, 2014-December 31, 2018, 300 publications were randomly sampled using a PubMed search. Additionally, we included four high-impact general medicine journals, which added 106 publications. Two investigators were blinded for independent extraction. Extracted data included statements regarding the availability of materials, data, analysis scripts, protocols, and registration.

RESULTS

After the search, we found 25,473 articles, from which we randomly selected 300. Of the 300, only 287 articles met the inclusion criteria. Additionally, we added 106 publications from high-impact journals of which 77 met the inclusion criteria. Together, 364 publications were included, of which 212 articles contained empirical data to analyze. Of the eligible empirical articles, 2.49%, (95% confidence interval [CI], 0.33% to 4.64%] provided a material statement, 9.91% (95% CI, 5.88% to 13.93%) provided a data statement, 0 provided access to analysis scripts, 25.94% (95% CI, 20.04% to 31.84%) linked the protocol, and 39.15% (95% CI, 32.58% to 45.72%) were preregistered.

CONCLUSION

Studies in EM lack indicators required for reproducibility. The majority of studies fail to report factors needed to reproduce research to ensure credibility. Thus, an intervention is required and can be achieved through the collaboration of researchers, peer reviewers, funding agencies, and journals.

An Immersive Multi-User Virtual Reality for Emergency Simulation Training: Usability Study

BACKGROUND

Virtual reality (VR) is increasingly used as simulation technology in emergency medicine education and training, in particular for training nontechnical skills. Experimental studies comparing teaching and learning in VR with traditional training media often demonstrate the equivalence or even superiority regarding particular variables of learning or training effectiveness.

OBJECTIVE

In the EPICSAVE (Enhanced Paramedic Vocational Training with Serious Games and Virtual Environments) project, a highly immersive room-scaled multi-user 3-dimensional VR simulation environment was developed. In this feasibility study, we wanted to gain initial insights into the training effectiveness and media use factors influencing learning and training in VR.

METHODS

The virtual emergency scenario was anaphylaxis grade III with shock, swelling of the upper and lower respiratory tract, as well as skin symptoms in a 5-year-old girl (virtual patient) visiting an indoor family amusement park with her grandfather (virtual agent). A cross-sectional, one-group pretest and posttest design was used to evaluate the training effectiveness and quality of the training execution. The sample included 18 active emergency physicians.

RESULTS

The 18 participants rated the VR simulation training positive in terms of training effectiveness and quality of the training execution. A strong, significant correlation (r=.53, P=.01) between experiencing presence and assessing training effectiveness was observed. Perceived limitations in usability and a relatively high extraneous cognitive load reduced this positive effect.

CONCLUSIONS

The training within the virtual simulation environment was rated as an effective educational approach. Specific media use factors appear to modulate training effectiveness (ie, improvement through "experience of presence" or reduction through perceived limitations in usability). These factors should be specific targets in the further development of this VR simulation training.

Effects of a Simulation-Based CPR Training Program on Knowledge, Performance, and Stress in Clinical Nurses

BACKGROUND

Rapid and accurate cardiopulmonary resuscitation (CPR) performed by clinical nurses plays an important role in increasing the survival rate of cardiac arrest patients in the hospital.

PURPOSE

This study examined the effects of a simulation-based CPR training program on knowledge, performance, and stress of CPR in clinical nurses.

METHOD

A quasi-experimental pretest-posttest control group design was used. Study participants included 60 clinical nurses (experimental group, n = 30, and control group, n = 30) in a general hospital in Seoul, South Korea. A 4-hour simulation-based CPR training program was conducted. Measures included the knowledge scale and performance scale from the Korean Association of Cardiopulmonary Resuscitation and the Post Code Stress Scale in Korean.

RESULTS

The simulation-based CPR training program significantly improved CPR knowledge (t = 4.664, p < .001) and performance (t = 4.940, p < .001), and decreased stress (t = -5.832, p < .001) in clinical nurses.

CONCLUSION

These findings indicate a simulation-based CPR training program was effective in improving knowledge and performing CPR, as well as in decreasing stress of CPR in clinical nurses. [J Contin Educ Nurs. 2020;51(5):225-232.].

Risk of bias assessment of randomised controlled trials referenced in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care: a cross-sectional review

OBJECTIVES

To identify the risk of bias of randomised controlled trials (RCTs) referenced in the 2015 American Heart Association (AHA) guidelines update for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC).

DESIGN

A cross-sectional review.

SETTING

All RCTs cited as references in the 2015 AHA guidelines update for CPR and ECC were extracted. After excluding non-human trials, studies that analysed existing RCTs, and RCTs published in a letter format, two reviewers assessed the risk of bias among RCTs included in this study.

OUTCOME MEASURES

The Cochrane Collaboration's tool for assessing the risk of bias in six domains (random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data and selective reporting) was used.

RESULTS

Two hundred seventy-three RCTs were selected for the analyses. Of these RCTs, 78.8% had a high risk of bias for blinding of participants and personnel, mostly (87.7%) non-drug trials. In drug trials, the proportion of trials with a low risk of bias for blinding of participants and personnel was 73.0%. The proportion of RCTs with an unclear risk of bias were higher for random sequence generation (38.5%) and allocation concealment (34.1%) than in other domains. Unclear risk of bias proportions was 65.4% for random sequence generation and 57.7% for allocation concealment before the introduction of Consolidated Standards of Reporting Trials (CONSORT) but decreased to 31.3% and 32.2% after the 2010 CONSORT update, respectively.

CONCLUSIONS

The proportion of RCTs with an unclear risk of bias was still high for random sequence generation and allocation concealment in the 2015 AHA guidelines for CPR and ECC. The risk of bias should be considered when interpreting and applying the CPR guidelines. Authors should plan and report their research using CONSORT guidelines and the Cochrane Collaboration's tool to reduce the risk of bias.