Ageing and Acute Care Physicians' Performance

December 6, 2024 updated by: Dr. Fahad Alam, Sunnybrook Health Sciences Centre

Impact of Acute Care Physician's Age on Crisis Management Performance and Learning After Simulation-based Education

The proportion of older acute care physicians (ACPs) has been increasing. Ageing is associated with physiological changes and research investigating how such age-related physiological changes affect clinical performance is lacking. Specifically, Crisis Resource Management (CRM) consists of essential clinical skills in acute care specialties which when absent, can significantly impact patient safety. As such, the goals of this study are to investigate whether ageing has a correlation with baseline CRM skills of ACPs and whether ageing influences learning from high fidelity simulation.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The proportion of older acute care physicians (ACP), emergency, critical care & anesthesia, has been steadily increasing. Ageing is associated with physiological changes, which in turn can influence a physician's clinical abilities and decision-making. The litigation and physician disciplinary data suggests that incidents involving all physicians are likely to occur later in practice, with degree of injury identified in the claims being of greater severity. However research, investigating how age-related physiological changes affect clinical performance and patient safety, is lacking.

CRM skills are essential skills within acute care specialties, and are vital for patient safety. CRM encompasses technical skills, as well as a rapid and organized approach to non-technical, cognitive skills such as decision-making, task management, situational awareness and team management. High-fidelity full body mannequin simulation-based education is effective for learning CRM, including transfer of skills from the simulated setting to the clinical setting and improving patient outcome. However, there is a gap in the literature on whether physicians' age influences baseline CRM performance and also learning from simulation-based education.

Although the effectiveness of high-fidelity simulation-based education has been studied extensively in junior learner populations (students, residents, fellows), there are a limited number of studies investigating its effectiveness in teaching CRM in the ageing physician population. In fact, a recent systematic review looking at the role of simulation in continuing medical education (CME) in ACPs supported that there is limited evidence supporting improved learning. Despite not knowing whether simulation is the correct tool in an ageing population, it is being recommended as a training, regulation and assessment tool for practicing physicians.

Objectives:

The goals of this study are to:

  1. Investigate whether ageing has a correlation with baseline CRM skills of ACPs using simulated crisis scenarios and
  2. Assess whether ageing influences learning from high fidelity simulation.

Study Type

Observational

Enrollment (Actual)

48

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontario
      • Ottawa, Ontario, Canada, K1H 8L6
        • University of Ottawa
      • Toronto, Ontario, Canada, M4N3M5
        • Sunnybrook Health Sciences Centre

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

Practicing emergency, critical care and anesthesia staff with a minimum 5 years of practice post residency will be approached for participation.

Description

Inclusion Criteria:

  • Emergency physicians
  • Critical care physicians
  • Anesthesiologists
  • minimum 5 years of practice post-residency

Exclusion Criteria:

  • Post-call day of participation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
CRM Simulation
Each participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test.
Other: CRM Simulation
Each participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
CRM Performance During First Sim Scenario Assessed by Ottawa Global Rating Scale (GRS)
Time Frame: After managing first simulation scenario - Day 1
Ottawa GRS score correlated with chronological age. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance.
After managing first simulation scenario - Day 1
CRM Performance During First Sim Scenario Assessed by ACLS Checklist
Time Frame: After managing first simulation scenario - Day 1
ACLS (Advanced Cardiac Life Support) score will be correlated with chronological age. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance.
After managing first simulation scenario - Day 1

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Learning From High-fidelity Simulation Education Assessed by Ottawa Global Rating Scale
Time Frame: After managing second simulation scenario - Day 1
Ottawa GRS score will be compared to score in first scenario to look for improvement. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance. The mean difference in GRS score between pre-test (scenario 1) and immediate post-test (scenario 2) is reported.
After managing second simulation scenario - Day 1
Learning From High-fidelity Simulation Education Assessed by ACLS Checklist
Time Frame: After managing second simulation scenario - Day 1
ACLS (Advanced Cardiac Life Support) score will be compared to score in first scenario to look for improvement. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance. The mean difference in ACLS score between pre-test (scenario 1) and immediate post-test (scenario 2) is reported.
After managing second simulation scenario - Day 1

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Retention of Learning From Simulation as Assessed by Ottawa Global Rating Scale
Time Frame: 3 months after completing first two scenarios - Day 90
Ottawa GRS score will be compared to score in second scenario on Day 1 to look for improvement. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance. The mean difference in GRS score between immediate post-test (scenario 2) and retention post-test (scenario 3) is reported.
3 months after completing first two scenarios - Day 90
Retention of Learning From Simulation as Assessed by ACLS Checklist
Time Frame: 3 months after completing first two scenarios - Day 90
ACLS (Advanced Cardiac Life Support) score will be compared to score in second scenario on Day 1 to look for improvement. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance. The mean difference in ACLS score between immediate post-test (scenario 2) and retention post-test (scenario 3) is reported.
3 months after completing first two scenarios - Day 90

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sunnybrook Health Sciences Centre

Collaborators

University of Toronto
University of Ottawa

Investigators

  • Principal Investigator: Sylvain Boet, MD, MEd, PhD, University of Ottawa
  • Principal Investigator: Fahad Alam, MD, FRCPC, Sunnybrook Health Sciences Centre

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2017

Primary Completion (Actual)

January 1, 2020

Study Completion (Actual)

January 1, 2020

Study Registration Dates

First Submitted

February 9, 2016

First Submitted That Met QC Criteria

February 16, 2016

First Posted (Estimated)

February 17, 2016

Study Record Updates

Last Update Posted (Actual)

March 25, 2025

Last Update Submitted That Met QC Criteria

December 6, 2024

Last Verified

December 1, 2024

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 140-2015

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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