Paradigm Shift: Using High-Fidelity Simulation as a Research Instrument

Paradigm Shift: Using High-Fidelity Simulation as a Research Instrument


Name: John E. Alex

Rank: CDR

Presenter/Poster: Podium and Poster

Year: 2017


High-fidelity simulation offers the potential to facilitate prospective data collection for en route care (ERC) through a standardized patient encounter, eliminating the limitations associated with retrospective reviews.

OBJECTIVES: Evaluate the scenario integrity and experience reproducibility of a high-fidelity simulation in a prospective, multi-site, observational study of two different provider groups.

BACKGROUND: Due to space, time and weight constraints, most prehospital and ERC research is limited to retrospective reviews. High-fidelity simulation enables prospective, objective evaluation and comparison of provider training. However, few data evaluating feasibility and effectiveness for research exist.

METHODS: A programmed scenario utilizing a Laerdal SimMan® was developed involving care of a critically injured patient during simulated aeromedical transport. A helicopter mock-up was created to mimic the space, light, and noise conditions encountered during a typical patient transport. In collaboration with expert observers, the investigators developed an evaluation tool used to consistently document scenario fidelity and correct performance of six pre-defined critical actions. Observers were blinded to the two different provider types and their level of en route care training and experience. Data were collected by two independent observers viewing live-streamed video from multiple camera angles; discordant observations were verified by a third observer reviewing the recorded audio-visual files. Effectiveness of the simulation was assessed by tracking the number of participants who completed the scenario, the number of study deviations related to simulation malfunctions or challenges, and the ability of observers to adequately discern and critique participant performance of the critical actions.

STUDY FINDINGS: Fifty-nine participants completed the scenario, 29 in Group A and 30 in Group B. Over 120 data elements were collected per participant. Of the 59 scenarios, eight (13.5%) experienced a documented protocol deviation. Of these, four (7%) were related to simulation malfunctions or challenges. Observers completed evaluation of all 59 participants in 100% of scenarios, and a third reviewer was required for only six (10%) of evaluations.

IMPLICATIONS FOR MILITARY NURSING: Simulation provides a valuable platform for research and holds considerable potential for the prospective evaluation of clinical performance needed to test training effectiveness for high risk patient care.

KEY WORDS: Simulation, Prehospital, En Route Care (ERC), Research methods