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Table 2 Study aims, interventions, simulation characteristics, outcomes, and main results

From: Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature

Study Aim Intervention Control group In situ/ex situ Fidelity level (low vs high level mannequin) Re-test (skill retention) Outcomes measure Main results
Bond et al. [22] To share the development of a telehealth solution for shared awareness between the in situ simulation professionals and the ED bedside team caring for the in situ simulated patient, and the eICU nurses participating via telehealth. 3/4 days workshop with in situ simulation.
Site A: 3 sim days
Site B: 4 sim days
No In situ Patient played by an actor and vital signs generated by Laerdal SimMan. No Pre-post self-confidence in using telehealth.
Pre-post self-confidence in managing ED patients with sepsis.
Telehealth was feasible with the equipment of choice.
Pre-post self-confidence in using telehealth increased from a mean ± SD of 5.3 ± 2.9 to 8.9 ± 1.1 (Δ3.5, p < 0.05). Self-confidence in managing ED patients with sepsis increased from a mean ± SD of 7.1 ± 2.5 to 8.9 ± 1.1 (Δ 1.8, p < 0.05).
Brewster et al. [23] To show a new inter-professional team-based simulation, ALS training package would improve critical care staff performance, understanding, and satisfaction with ALS training A 4-h workshop No NR Resusci Anne®Simulator Questionnaire 4 months after workshop attendance. Changes in questionnaire scores pre-course, immediately after, and 4 months after simulation training. Overall ICU nursing attendance increased from 54 to 71%.
Nurses gave higher scores for all criteria when assessing the new ALS training program compared to the previous program.
No significant improvement in perceptions of team performance.
Chan et al. [24] To evaluate the attitude of participants and their change in knowledge on clinical performance after attending a new training workshop. 2-day workshop (eight 1-h scenarios) No Ex situ NR No Knowledge multiple-choice questionnaire. Improved knowledge of clinical performance and training was well received.
Couto et al. [25] To detect LST in a training program, which combined in situ simulation scenarios with just-in-time and just-in-place self-directed task training in an ED. 4 simulation weeks with in situ simulation in a year, 14–15 scenarios per simulation week; 10 min scenario, 10 min debriefing. No In situ High-fidelity mannequin (SimMan 3G, SimBaby or SimNewB, Laerdal) No LST detected during debriefing. The training allowed a high rate of detecting LST regardless of theme. Equipment-related LST were more frequently found.
Dagnone et al. [26] To share the development and evaluation of a simulation-based competition. 3-day simulation-based competition, 3–4 scenarios per team. No Ex situ Trained standardized actors No Characteristic of participants, their attitudes toward simulation, and their evaluation of the competition. Participants were extremely satisfied with the event and expressed a strong desire to expand interdisciplinary team training in resuscitation.
Hicks et al. [27] To evaluate the feasibility of a simulation-based CRM curriculum for EM residents and identify shifts in team-based behaviors and attitudes. Precourse learning and 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Four scenarios in total. No Ex situ Two high-fidelity scenarios and two low-fidelity scenarios No Pre/post scenarios were scored using Ottawa CRM GRS. Pre-post survey on human factor attitude. Quality, relevance, and potential impact of training were highly positive.
Improvement in Ottawa GRS, but not statistically significant from pre- to post-course.
Marker et al. [28] To identify first-year doctors’ perceptions, reactions, and reflection on transfer of skills after simulation-based training 4-days simulation-based training. No Ex situ High-fidelity No Interviews Increased preparedness.
Useful algorithms.
Better communication and teamwork.
Meurling et al. [29] To explore differential individual training effects for physicians, nurses, and nurse assistants on self-efficacy and experienced quality of collaboration and communication between professionals 4 h of interactive seminars concerning safe teamwork.
1 day of simulation training, with a team comprising 6 persons.
Each team experienced 3–4 scenarios.
Yes In situ High-fidelity No Self-efficacy questionnaire.
Staff turnover and sick leave.
Self-efficacy: The effect for women was 0.21 (95% CI 0.039 to 0.371) and for men 0.59 (95% CI 0.308 to 0.876).
SAQ: Discrepant attitudes about teamwork between physicians and nurses. The scores for safety climate improved for nurses. Physicians did not change in scores.
Sick leave: Nurse assistants decreased their sick leave from 28 to 12%.
Paltved e t al [30]. To enhance patient safety attitudes through the design of an in situ simulation program based on a needs analysis involving thematic analysis of patient safety data and short-term ethnography. One scenario, 2 h per team (45-min scenario, 50-min debriefing) No In situ Simulated patients No SAQ and Trainee Reactions Score An in situ simulation program can act as a significant catalyst for improvement in emergency staff’s safety and teamwork attitudes that might correlate with a more positive patient safety culture.
Parsons et al. [31] To design a CRM course for ED residents and to test the course’s efficacy. ½-h lecture followed by 6 simulation scenarios, 3 active and 3 observed.
Scenarios of 15 min with 30 min debrief.
No Ex situ High-fidelity (actor or SimMan3G) No Ottawa CRM GRS. Increase in score concerning leadership, problem solving, situational awareness, resource utilization, and communication. Not statistically significant.
Rasmussen et al. [32] To identify long-term intended and unintended learner reactions, experiences, and reflections after attending a simulation-based ALS course. ALS course. Duration NR No Ex situ NR No Interviews “(…) the efficiency dimension of ALS competence is taught well in ALS courses, but that the form and content of these highly structured/model courses are insufficient in training the innovative dimension of competence that is needed for transfer of skills in unstructured, emergency situations.”
Truta et al. [33] To assess whether a CRM-oriented team training combining didactic and simulation sessions improves interprofessional EM team performance of non-technical skills. 1-day (6–7 h) lecture and 6 scenarios (3 active + 3 observed) No In situ and ex situ High-fidelity manikin Post-test 2 months after intervention Scale from Flowerdew et al [35]. Improvement in management and supervision, teamwork and cooperation, decision-making, and situational awareness. Statistically significant improvements in all groups of participants.
Wong et al. [34] To investigate agitation care delivery and to evaluate the impact of a team-based simulation on ED staff. 2-h course, 15 min simulation, focus group interview No In situ Low-fidelity No KidSIM ATTITUDES questionnaire.
Uniprofessional and interprefessional focus group interviews.
KidSIM: Improvements in attitudinal scores for all questions within the relevance of simulation and opportunities for interprofessional education constructs (all p < 0.001).
Interviews: The interprofessional conversations fostered insightful discussions regarding the development of novel team-based strategies and solutions for improved agitation management.
  1. NR not relevant, ED emergency department, EM emergency medicine, eICU, ALS advanced life support, LST latent safety threats, CRM crisis resource management, GRS Global Rating Scale, SAQ Safety Attitudes Questionnaire