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ECONOMICS, EDUCATION, AND POLICY

Personalized Oral Debriefing Versus Standardized Multimedia Instruction After Patient Crisis Simulation

Timothy M. Welke, MD^*, Vicki R. LeBlanc, PhD^*, Georges L. Savoldelli, MD, MEd^*, Hwan S. Joo, MD^*, Deven B. Chandra, MD^*, Nicholas A. Crabtree, MB ChB^*, and Viren N. Naik, MD, MEd^*

From the *St. Michael’s Anesthesia Research into Teaching (SMART) Simulation Group, Department of Anesthesia, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada; Wilson Centre for Research in Education, University Health Network, University of Toronto, Toronto, Ontario, Canada; and Department of Anesthesia and Unit for Development and Research in Medical Education, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland.

Address correspondence to Viren N. Naik, MD, MEd, FRCPC, Department of Anesthesia, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, ON, Canada M5B 1W8. Address e-mail to naikv{at}smh.toronto.on.ca.

Abstract

BACKGROUND: Simulation experience alone without debriefing is insufficient for learning. Standardized multimedia instruction has been shown to be useful in teaching surgical skills but has not been evaluated for use as an adjunct in crisis management training. Our primary purpose in this study was to determine whether standardized computer-based multimedia instruction is effective for learning, and whether the learning is retained 5 wk later. Our secondary purpose was to compare multimedia instruction to personalized video-assisted oral debriefing with an expert.

METHODS: Thirty anesthesia residents were recruited to manage three different simulated resuscitation scenarios using a high-fidelity patient simulator. After the first scenario, subjects were randomized to either a computer-based multimedia tutorial or a personal debriefing of their performance with an expert and videotape review. After their respective teaching, subjects managed a similar posttest resuscitation scenario and a third retention test scenario 5 wk later. Performances were independently rated by two blinded expert assessors using a previously validated assessment system.

RESULTS: Posttest (12.22 ± 2.19, P = 0.009) and retention (12.80 ± 1.77, P < 0.001) performances of nontechnical skills were significantly improved in the standardized multimedia instruction group compared with pretest (10.27 ± 2.10). There were no significant differences in improvement between the two methods of instruction.

CONCLUSION: Computer-based multimedia instruction is an effective method of teaching nontechnical skills in simulated crisis scenarios and may be as effective as personalized oral debriefing. Multimedia may be a valuable adjunct to centers when debriefing expertise is not available.