La simulation : du Task-Trainer au Crisis Resource Management, un défi pédagogique pour la médecine d’urgence

Le débriefing par revue après action pour la simulation en santé : applications à la médecine d’urgence

Introduction : Le débriefing est une analyse postévénementielle qui est une partie fondamentale du processus d’apprentissage par simulation. Il est une évaluation formative permettant d’explorer les raisons des déficits de performance dans un objectif d’amélioration des performances. La revue après action (RAA) est une technique du débriefing développée par l’armée américaine et qui explore en équipe les intentions derrière les actions. L’objectif de ce travail a été de décrire les principes de la revue après action en tant que technique et d’en déterminer l’intérêt, les avantages et les inconvénients en simulation en santé, notamment en médecine d’urgence.

Méthodes : Revue narrative de la littérature traitant du débriefing en simulation par revue après action. Après analyse de la littérature dans les bases Medline, Web of Science, ScienceDirect, Pascal & Francis et Defense Technical Information Center, les articles ont été inclus s’ils répondaient aux critères suivants : apprentissage par simulation, revue après action comme méthode de débriefing.

Résultats : Quinze manuscrits ont été inclus. La revue après action permet une analyse non punitive et objective de la simulation. Ses principales forces sont d’analyser collectivement les performances d’équipe et de proposer des mesures correctives. Ses principales limites sont l’absence de débriefing individuel et son inefficacité en cas d’insuffisance de formation du débriefeur.

Conclusion: La revue après action est un format de débriefing favorisant les apprentissages et l’amélioration des performances d’équipe, mais explore peu les performances individuelles.

Massive Hemorrhage Protocol Application and Teamwork Skills

OBJECTIVE

Massive hemorrhages (MHs) are rare but serious complications of pediatric trauma and obstetric cases. This study aimed to evaluate the impact of interprofessional simulation to improve adherence to a MH protocol (MHP), teamwork skills and confidence levels during a hemorrhagic crisis situation.Methods: This was a pre-post experimental study conducted at a tertiary care mother-child simulation center. Pediatric emergency and obstetric teams were submitted to simulated trauma and postpartum MH scenarios. Training consisted of two case scenarios followed by debriefing sessions and a lecture on the MHP. The primary outcome was adherence to MHP processes (checklist) measured prior to and 2 weeks following training sessions. Other outcomes were the measure of teamwork skills (Mayo High Performance Teamwork Scale) and confidence of the participants.

RESULTS

Sixty-two health care professionals were involved in eight interprofessional teams. Mean scores for adherence to the MHP improved from 19.1 in the pretraining phase to 25.8 in the posttraining phase (difference of 6.7; 95% confidence interval [CI] = 4.4 to 8.9). Mean scores pertaining to teamwork skills also improved significantly between pre- and posttraining phases (difference = 3.9; 95% CI = 1.5 to 6.4). Confidence questionnaires showed significant improvements in the posttraining phase (difference = 6.9; 95% CI = 5.3 to 8.3).

CONCLUSIONS

Targeted training involving simulation and protocol review improved participant adherence to MHP processes and teamwork skills. Confidence levels improved across all disciplines.

Long-term retention assessment after simulation-based-training of pediatric procedural skills among adult emergency physicians: a multicenter observational study

BACKGROUND

One of the primary goals of simulation-based education is to enable long-term retention of training gains. However, medical literature has poorly contributed to understanding the best timing for repetition of simulation sessions. There is heterogeneity in re-training recommendations.

OBJECTIVES

This study assessed, through simulation-based training in different groups, the long-term retention of rare pediatric technical procedures.

METHODS

This multicenter observational study included 107 emergency physicians and residents. Eighty-eight were divided into four groups that were specifically trained for pediatric emergency procedures at different points in time between 2010 and 2015 (< 0.5 year prior for G1, between 0.5 and 2 years prior for G2, between 2 and 4 years prior for G3, and ≥ 4 years prior for G4). An untrained control group (C) included 19 emergency physicians. Participants were asked to manage an unconscious infant using a low-fidelity mannequin. Assessment was based on the performance at 6 specific tasks corresponding to airway (A) and ventilation (B) skills. The performance (scored on 100) was evaluated by the TAPAS scale (Team Average Performance Assessment Scale). Correlation between performance and clinical level of experience was studied.

RESULTS

There was a significant difference in performance between groups (p < 0.0001). For G1, 89% of the expected tasks were completed but resulted in longer delays before initiating actions than for the other groups. There was no difference between G4 and C with less than half of the tasks performed (47 and 43% respectively, p = 0.57). There was no correlation between clinical level of experience and performance (p = 0.39).

CONCLUSION

Performance decreased at 6 months after specific training for pediatric emergency skills, with total loss at 4 years after training, irrespective of experience. Repetition of simulation sessions should be implemented frequently after training to improve long-term retention and the optimal rate of refresher courses requires further research.