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Proficiency-Based Progression Training for Clinical Communication

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ClinicalTrials.gov Identifier: NCT02886754
Recruitment Status : Completed
First Posted : September 1, 2016
Last Update Posted : July 25, 2017
Sponsor:
Information provided by (Responsible Party):
Dorothy Breen, University College Cork

Brief Summary:

Importance: Clinical communication is an important source of medical error and preventable adverse events.

Objective: To determine the effectiveness of proficiency-based progression (PBP) simulation training for ISBAR (Identify, Situation, Background, Assessment, Recommendation) communication in the deteriorating patient.

Setting: The study will be conducted in University College Cork, Ireland. Participants: Third year undergraduate nursing and fifth year medical students, who are scheduled to undertake ISBAR training as part of the National Early Warning Score (NEWS) programme.

Intervention: Participants will be prospectively randomized to one of three groups before undertaking a performance assessment of an ISBAR communication relevant to a deteriorating patient in a high fidelity simulation laboratory: HSE group (the national e-learning programme only); S group (national e- learning plus simulation training) and PBP group (national e-learning plus proficiency-based progression simulation).

Main outcome and measures: A proficiency benchmark on the performance of ISBAR communication in the context of an acutely deteriorating patient.


Condition or disease Intervention/treatment Phase
Clinical Communication ISBAR Simulation Proficiency-Based Progression Non Technical Skills Performance Deteriorating Patient Behavioral: Proficiency-based progression Behavioral: National e-learning programme only Behavioral: Standard simulation Not Applicable

Detailed Description:

The first successful simulation validation study used a proficiency-based progression methodology. Since then the approach has been successfully deployed to produce superior technical skills but has not yet been validated for non-technical (communication) skills. The ISBAR (Identify, Situation, Background, Assessment and Recommendation) has been selected as the standardised tool for clinical communication in relation to an acutely deteriorating patient in many healthcare organisations worldwide, including Ireland.

The aim of this study is to explore whether proficiency-based progression (PBP) could be applied to simulation-based training for ISBAR performance to produce a superior skill set.

The study will compare performance outcomes of students, who receive the national e-learning programme only with those who receive it in combination with either standard simulation or proficiency-based progression (PBP) simulation.

Participants will be prospectively randomized to one of three training groups within their professional cohort (medicine or nursing) before undertaking a performance assessment of an ISBAR communication relevant to a deteriorating patient in a high fidelity simulation laboratory:

  1. Online learning only (HSE) -the national e-learning programme only
  2. Standard simulation (S) -online learning plus simulation training
  3. Proficiency based progression (PBP) -online learning plus proficiency-based progression simulation.

Main outcome and measures: A proficiency benchmark on the performance of ISBAR communication in the context of an acutely deteriorating patient.

All participants will be required to demonstrate a certificate of successful completion on the national e-learning programme within the previous 4 weeks as well as supplying baseline demographic information before undertaking the training.

Performance metrics have previously been identified, operationally defined and agreed upon at a modified Delphi panel meeting consisting of medical and nursing experts for a series of paper-based simulation cases and a standardised high fidelity simulation case used as the assessment case. The proficiency benchmark for each case has been set based on the performance of experienced nursing and medical personnel on each case as a series of steps, errors and critical errors.

Outcome assessment will be scored by reviewing recordings of ISBAR performance by each participant on the standardised case in the high fidelity laboratory.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 77 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The study design is a parallel group, double-blind, randomized trial
Masking: Double (Participant, Outcomes Assessor)
Masking Description: Participants and outcome assessors were unaware of which intervention group subjects were allocated
Primary Purpose: Other
Official Title: The Effect of a Proficiency Based Progression Training Programme for Clinical Communication on ISBAR Performance
Actual Study Start Date : September 14, 2016
Actual Primary Completion Date : September 16, 2016
Actual Study Completion Date : September 16, 2016

Arm Intervention/treatment
Active Comparator: National e-learning programme only (HSE)
National e-learning programme only Recent successful completion the National e-learning programme by certificate will be displayed. Students then complete a student satisfaction survey and proceed directly for performance assessment to the high-fidelity simulation suite.
Behavioral: National e-learning programme only
National e-learning programme (COMPASS)
Other Name: HSE

Active Comparator: Simulation (S)
Simulation Recent successful completion of the National e-learning e-learning programme by certificate will be displayed. Students will proceed to standard simulation using the same series of paper cases as PBP which prompt simulated phone calls but no requirement to meet a proficiency benchmark. 4 hours will be allotted to this training. Following training participants will complete the student satisfaction survey and will then proceed directly for performance assessment to the high-fidelity simulation suite.
Behavioral: National e-learning programme only
National e-learning programme (COMPASS)
Other Name: HSE

Behavioral: Standard simulation
Paper based simulation cases
Other Name: Simulation S

Experimental: Proficiency-Based Progression (PBP)
Recent successful completion of the National e-learning programme by certificate will be displayed. Students will proceed to PBP simulation using the same series of paper cases as S which prompt simulated phone calls. PBP students will be scored according to predefined metrics and will be required to reach proficiency benchmarks. Following training participants will complete the student satisfaction survey and proceed directly for performance assessment to the high-fidelity simulation suite.
Behavioral: Proficiency-based progression
Use of validated metrics and performance benchmarks to simulation training
Other Name: PBP

Behavioral: National e-learning programme only
National e-learning programme (COMPASS)
Other Name: HSE




Primary Outcome Measures :
  1. Proportion of those reaching the benchmark on the assessment case [ Time Frame: 6 months ]
    Independent review by two blinded assessors of recorded ISBAR phone call conducted in the high fidelity simulation setting


Secondary Outcome Measures :
  1. Number of completed steps [ Time Frame: 6 months ]
    Number of successfully completed steps as predefined by the metrics for the assessment case


Other Outcome Measures:
  1. Number of total errors [ Time Frame: 6 months ]
    Number of total errors as predefined by the metrics for the assessment case

  2. Number of errors/critical errors [ Time Frame: 6 months ]
    Number of errors/critical errors as predefined by the metrics for the assessment case



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Third year undergraduate nursing students

Fifth year medical students

Exclusion Criteria:

Lack of consent

Failure to successfully complete the National e-learning NEWS programme


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): NCT02886754


Locations
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Ireland
University College Cork
Cork, Ireland, T12EH31
Sponsors and Collaborators
University College Cork
Investigators
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Study Director: Anthony Gallagher, PhD, DSc University College Cork, College Rd, Cork Ireland
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Dorothy Breen, Specilaist in Intensive Care and Director of Education, ASSERT, Principal Invesitgator, University College Cork
ClinicalTrials.gov Identifier: NCT02886754    
Other Study ID Numbers: ISBAR
First Posted: September 1, 2016    Key Record Dates
Last Update Posted: July 25, 2017
Last Verified: July 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Keywords provided by Dorothy Breen, University College Cork:
Clinical Communication
ISBAR
Simulation
Performance
Non technical skills
Proficiency
Additional relevant MeSH terms:
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Disease Progression
Disease Attributes
Pathologic Processes