Using impromptu in-situ simulation to evaluate a training program - a pilot feasibility study.

Abstract

Background: Skill-based courses are frequently utilised in modern multidisciplinary education to achieve competency in key aspects of practice. The gold-standard in education evaluation is to demonstrate the intervention has improved clinical outcomes. When the training involves a low frequency event this becomes impractical and unfeasible. We performed a feasibility study to examine the use of impromptu, in-situ, high fidelity, immersive simulation to evaluate clinical performance following a Cardiac Surgery Advanced Life Support (CALS) training program.

Method: Prospective single-centre before and after evaluation of a CALS training program using in-situ, impromptu, high fidelity, immersive simulation. The primary outcome was feasibility of assessment as measured by total cost and staff time. Secondary outcomes included a performance score out of 17 and time to internal cardiac massage (ICM).

Results: The total resources required were $14000 for equipment, 555 minutes of staff time for planning and 60 minutes of staff time per scenario assessed. Eighteen scenarios of 5 to 10 minutes were completed, with 5 participants per scenario. The median(IQR) time to ICM improved from 600(488-620) seconds at baseline to 271(242-274) seconds post training, p= 0.0003. Overall performance score improved from a median(IQR) of 6(5-6) pre-training to 12(12-14) post-training, p=0.0003.

Conclusion: Impromptu, in-situ, high fidelity, immersive simulation is a feasible means of evaluating CALS training. There were significant improvements in both overall performance and time to ICM in this small pilot study. This technique may be used in future multi-centre studies evaluating the effectiveness of CALS training.