Effect of a proficiency-based progression simulation programme on clinical communication for the deteriorating patient: a randomised controlled trial

Abstract

ObjectiveThis study aimed to determine the effectiveness of a proficiency-based progression (PBP) training approach to clinical communication in the context of a clinically deteriorating patient.DesignThis is a randomised controlled trial with three parallel arms.SettingThis study was conducted in a university in Ireland.ParticipantsThis study included 45 third year nursing and 45 final year medical undergraduates scheduled to undertake interdisciplinary National Early Warning Score (NEWS) training over a 3-day period in September 2016.InterventionsParticipants were prospectively randomised to one of three groups before undertaking a performance assessment of the ISBAR (Identification, Situation, Background, Assessment, Recommendation) communication tool relevant to a deteriorating patient in a high-fidelity simulation facility. The groups were as follows: (i) E, the Irish Health Service national NEWS e-learning programme only; (ii) E+S, the national e-learning programme plus standard simulation; and (iii) E+PBP, the national e-learning programme plus PBP simulation.Main outcome measuresThe primary outcome was the proportion in each group reaching a predefined proficiency benchmark comprising a series of predefined steps, errors and critical errors during the performance of a standardised, high-fidelity simulation assessment case which was recorded and scored by two independent blinded assessors.Results6.9% (2/29) of the E group and 13% (3/23) of the E+S group demonstrated proficiency in comparison to 60% (15/25) of the E+PBP group. The difference between the E and the E+S groups was not statistically significant (χ2=0.55, 99% CI 0.63 to 0.66, p=0.63) but was significant for the difference between the E and the E+PBP groups (χ2=22.25, CI 0.00 to 0.00, p<0.000) and between the E+S and the E+PBP groups (χ2=11.04, CI 0.00 to 0.00, p=0.001).ConclusionsPBP is a more effective way to teach clinical communication in the context of the deteriorating patient than e-learning either alone or in combination with standard simulation.Trial registration numberNCT02886754; Results.

Objective assessment of intraoperative skills for robot‐assisted radical prostatectomy (RARP): results from the ERUS Scientific and Educational Working Groups Metrics Initiative

“…Proficiency based progression (PBP) training offers objective and validated performance metrics to track progression of the trainee and operative skill on a specific task or procedure (which is performed in the training laboratory on virtual simulators and animal models) before the trainees start their clinical practice in the operating theatre on patients [ 3 , 4 , 5 , 6 ]. In prospective, randomised and blinded studies it has been repeatedly shown that metric‐based simulation training to proficiency produces superior surgical skills in comparison to traditional training approaches [ 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. There is also evidence that a PBP simulation training impacts on clinical outcomes [ 8 ].…”

European expert consensus on a structured approach to training robotic‐assisted low anterior resection using performance metrics

“…The approach used to characterize an RA-LAR in this study provides structured and objective metrics that are explicit and transparent and allow learners to focus on achieving the steps required before progress to the next level -PBP training. This PBP training has been utilized in different specialities and has been shown to significantly reduce intra-operative errors [18,19,[21][22][23][24][25]42]. Furthermore, the metrics will serve as a template for trainers to provide structured training for a surgical procedure.…”

“…This method has been applied to specialities including orthopaedics [15,17], cardiology [14,18], anaesthetics [16,19] and interventional neuroradiology [13,20]. PBP training has been shown to significantly reduce intra-operative errors (> 40%) [18,19,[21][22][23][24][25]. Therefore, the ESC aims to introduce this scientific training approach in the robotic colorectal surgery training programme.…”

Do surgical skills affect outcomes?

“…The PBP method allows an ease of assessment and appraisal process for both technical and nontechnical skills. This model has not yet been applied in colorectal surgery but it has to other different specialities and has been shown to significantly reduce objectively assessed intra-operative errors (>40%) [23][24][25][26][27][28][29]. Undoubtedly other factors, including knowledge, nontechnical skills, a team approach in decision making and regular audit, further optimize the care delivered to our patients, but surgeons intra-operative skills remain imperative (Fig.…”