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Ageing and Acute Care Physicians' Performance

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02683447
Recruitment Status : Active, not recruiting
First Posted : February 17, 2016
Last Update Posted : July 16, 2019
Sponsor:
Collaborators:
University of Toronto
University of Ottawa
Information provided by (Responsible Party):
Dr. Fahad Alam, Sunnybrook Health Sciences Centre

Brief Summary:
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.

Condition or disease Intervention/treatment
Ageing Other: CRM Simulation

Detailed Description:

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:

  1. Investigate whether ageing has a correlation with baseline CRM skills of ACPs using simulated crisis scenarios and
  2. Assess whether ageing influences learning from high fidelity simulation.

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Study Type : Observational
Estimated Enrollment : 70 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Impact of Acute Care Physician's Age on Crisis Management Performance and Learning After Simulation-based Education
Actual Study Start Date : January 2017
Estimated Primary Completion Date : June 2020
Estimated Study Completion Date : June 2020

Group/Cohort Intervention/treatment
CRM Simulation
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
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.




Primary Outcome Measures :
  1. CRM Performance during first sim scenario assessed by Ottawa Global Rating Scale (GRS) [ Time Frame: After managing first simulation scenario - Day 1 ]
    Ottawa GRS score will be correlated with age

  2. CRM Performance during first sim scenario assessed by ACLS checklist [ Time Frame: After managing first simulation scenario - Day 1 ]
    ACLS score will be correlated with age


Secondary Outcome Measures :
  1. Learning from high-fidelity simulation education assessed by Ottawa Global Rating Scale [ Time Frame: After managing second simulation scenario - Day 1 ]
    Ottawa GRS score will be compared to score in first scenario to look for improvement

  2. Learning from high-fidelity simulation education assessed by ACLS checklist [ Time Frame: After managing second simulation scenario - Day 1 ]
    ACLS score will be compared to score in first scenario to look for improvement


Other Outcome Measures:
  1. Retention of learning from simulation as assessed by Ottawa Global Rating Scale [ Time Frame: 3 months after completing first two scenarios - Day 90 ]
    Ottawa GRS score will be compared to score in second scenario on Day 1 to look for improvement

  2. Retention of learning from simulation as assessed by ACLS checklist [ Time Frame: 3 months after completing first two scenarios - Day 90 ]
    ACLS score will be compared to score in second scenario on Day 1 to look for improvement



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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Practicing emergency, critical care and anesthesia staff with a minimum 5 years of practice post residency will be approached for participation.
Criteria

Inclusion Criteria:

  • Emergency physicians
  • Critical care physicians
  • Anesthesiologists
  • minimum 5 years of practice post-residency

Exclusion Criteria:

  • Post-call day of participation

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02683447


Locations
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Canada, Ontario
University of Ottawa
Ottawa, Ontario, Canada, K1H 8L6
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada, M4N3M5
Sponsors and Collaborators
Sunnybrook Health Sciences Centre
University of Toronto
University of Ottawa
Investigators
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Principal Investigator: Fahad Alam, MD, FRCPC Sunnybrook Health Sciences Centre
Principal Investigator: Sylvain Boet, MD, MEd, PhD University of Ottawa
Publications:
Duke, E. (2006). The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians : Report to Congress (p. 36). U.S. Department of Health & Human Sciences.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Dr. Fahad Alam, Anesthesiologist, Sunnybrook Health Sciences Centre
ClinicalTrials.gov Identifier: NCT02683447    
Other Study ID Numbers: 140-2015
First Posted: February 17, 2016    Key Record Dates
Last Update Posted: July 16, 2019
Last Verified: July 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Dr. Fahad Alam, Sunnybrook Health Sciences Centre:
Continuing Medical Education
Simulation
Non-technical Skills
Crisis Resource Management