Alert 2014-new-pennaforte

Is simulation-based training an effective method for the

acquisition of clinical reasoning in neonatology ?

Thomas Pennaforte

CHU Sainte-Justine, Montreal, Canada

IMSH 2014: San Francisco, CA / USA

International Network for Simulation-based Pediatric Innovation, Research and Education


Background 1

• Simulation in neonatology : Neonatal Resuscitation Program

cognitive, technical & behavioral skills

• Complex situations in NICU

No guidelines, context of uncertainty

clinical reasoning


Background 2

Reasoning

Process

Factual knowledgeFactual knowledgeFactual knowledge

Clinical Reasoning

ASSESSMENT TOOLS

MCQ

Key Feature Problem

Script Concordance Tests

Clinical Reasoning Problem

Key Feature ProblemKey Feature Problem



Key Feature Problem

Data interpretation

Hypothesis generation

Decision making

Data identification

Data interpretation

Key Feature Problem



Key Feature Problem

Data interpretation


Decision making

Data identification

Data interpretation

Key Feature Problem



Key Feature Problem

Data interpretation


Decision making

Data identification

Data interpretation


The PICO question

• Population Pediatric residents and neonatology fellows

• Intervention Simulation-based training

• Comparison Traditional classroom training

• Outcome Clinical reasoning peformance


Design

Pre-TestMCQ, SCT, CDM, CRP

TRAD groupn=25

SIM groupn=25

Retesting

Randomization

Post-TestMCQ, SCT, CDM, CRP


Timeline

• Jan. and Feb 2014 : test’s construction

• March 2014 : evaluation of test’s interest by students from

others universities

• May 2014 : Pilot study with French participants

• Mid 2014 : Final study with Canadian participants

• Data analysis, article redaction and submission

• Is a Pre-Test necessary ?

• How many topics should be covered?

– One topic = 60 min PPT vs 2 topics = 120 min !

• Simulation training ?

– One scenario (1 hr) vs. two short (30 min) scenarios ?

– If 2 scenarios: repeat scenario or 2 different scenarios

• Should scientific resources be given to participants ? Both

groups? At what time?


Need INSPIRE help !

Thomas PENNAFORTE

CHU Sainte-Justine

Montreal, Canada

[email protected]


Contact Information

1. Short clinical scenario

Always incorporate uncertainty. Several options are relevant to

solve the diagnostic or management problem posed by the situation.

2. Questions in three parts1. "if you were thinking of" contains a relevant diagnostic or

management option2. "and then you were to find" presents a new clinical finding,

such as a physical sign, a pre-existing condition, an imaging study or a laboratory test result.

3. "this option would become" is a five-point Likert scale that

captures examinees' decisions.



Data interpretation


Patient presentation, history and physical examination

2. Questions

1. What do you think is the most likely diagnosis in this patient?

2. List the features of the case which you consider support your diagnosis and also those which oppose it, giving an appropriate

sign [positive (+) or negative (-)] and weighting to each.

3. If this diagnosis proved incorrect, what would your next choice be?

4. List the features of the case which you consider support your diagnosis and also those which oppose it, giving an appropriate

sign [positive (+) or negative (-)] and weighting to each.


Clinical Reasoning Problems

Data interpretation Hypothesis generationData identification


Patient presentation, history and physical examination

2. Questions

1. What is your leading diagnosis at this time?

2. What steps will you take in your immediate assessment and management of this patient ? Select as many as are appropriate 3. …


Key Feature Problems

Data interpretation Hypothesis generationData identification

Decision making