Education, Teaching, and Quality Improvement |

A Comparison of Simulation Training Versus Classroom-Based Education in Teaching Situation Awareness: Randomized Control Study FREE TO VIEW

Alfredo Lee Chang, MD; Akiva Dym; Carla Venegas-Borsellino; Maneesha Bangar, MD; Massoiud Kazzi, MD; Dmitry Lisenenkov, MD; Nida Qadir, MD; Lewis Eisen, MD; Adam Keene, MD
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Montefiore Medical Center, Bronx, NY

Chest. 2015;148(4_MeetingAbstracts):461A. doi:10.1378/chest.2259205
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SESSION TITLE: Education and Simulation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Situation awareness (SA) has been defined as “the perception of the elements in the environment within volumes of time and space, the comprehension of their meaning, and the projection of their status in the near future”. Intensivists often make time-sensitive critical decisions, and loss of SA can lead to errors. Training on SA has improved outcomes in the military and aviation industry. It has been shown that simulation-based training (SBT) is superior to lecture-based training (LBT) for some critical scenarios. Since adequate training to improve SA has not been well studied in the medical field, we compared the impact of SBT versus LBT on the Situation Awareness Global Assessment Technique (SAGAT) score.

METHODS: We randomly assigned 10 critical care fellows to SBT or lecture on SA. Training consisted of 8 cases on airway management, including topics such as: elevated intracranial pressure, difficult airway, arrhythmia, and shock. At random times between 4 and 6 minutes the scenario was frozen and the monitor was blanked. Respondents filled out the (28 Point) SAGAT scale. Sample items included Perception items (e.g. What is the current heart rate?); Comprehension items (e.g. Does the patient need more medication?); and Projection items (e.g. How will the oxygen saturation develop in the next minute?) Results were compared using STATA/IC 11.2. Comparisons of the means were performed with a two tailed t-test or Mann-Whitney U-test as appropriate. P<0.05 was considered significant.

RESULTS: Six fellows underwent SBT and four fellows LBT. 32 and 24 SAGAT scores were recorded in the SBT and LBT, respectively. The mean SBT versus LBT SAGAT score was 61.71±7.71 and 60.26±11.88, p=0.6, respectively. There was a trend towards difference in the mean Perception between SBT vs. LBT [62.32±8.66 vs. 57.17±11.4, p=0.06] but there was no difference in the Projection and Comprehension between SBT vs. LBT. [37.5±24.78 vs. 50±32.13, p=0.342; 83.3±24.53 vs. 83.3±18.26, p=0.289], respectively.

CONCLUSIONS: We found no difference between SBT and LBT on the SAGAT score of overall situation awareness though there was a trend towards improvement in Perception. Simulation is not a definitively superior method of learning SA.

CLINICAL IMPLICATIONS: Improvement of SA might improve life-saving decision making in emergent situations. However, effective methods to improve SA training require further study.

DISCLOSURE: The following authors have nothing to disclose: Alfredo Lee Chang, Akiva Dym, Carla Venegas-Borsellino, Maneesha Bangar, Massoiud Kazzi, Dmitry Lisenenkov, Nida Qadir, Lewis Eisen, Adam Keene

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