Crisis Resource Management Improvement Through Intellectual Questioning of Authority (CRITIQue)

This is a randomized controlled trial examining the effectiveness of a teaching intervention on residents' and medical students' ability to challenge clearly wrong decisions by a superior during a simulated life-threatening crisis. Participants will be randomly allocated into the control or intervention arm. The intervention arm will receive education on crisis resource management (CRM) and teaching targeting the cognitive skills required to monitor and challenge a superior's decision, and conflict resolution tools. Participants will then take part in a simulation scenario 2 to 4 weeks later and will be assessed based on 6 challenge points, followed by a debrief session.

Study Overview

• Status: Completed
• Conditions: Medical Education, Simulation, Crisis Resource Management
• Intervention / Treatment: Other: Standard ACLS Training; Other: Crisis Resource Management Skill Training

• Study Type: Interventional
• Enrollment (Actual): 25
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Singapore
  • Singapore, Singapore, 119085
    • National University Hospital, Singapore

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Medical officers or Internal medicine, surgical and emergency medicine residents who are in their 2nd post-graduate year of training, or
• Phase V medical students from Yong Loo Lin School of Medicine, National University of Singapore

Exclusion Criteria:

• Refusal for informed consent, or
• Refusal for video recording during simulation sessions

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Control; Subjects allocated to the control arm will receive standard didactic interactive session on Advanced Cardiac Life Support (ACLS) principles, as part of their regular teaching schedule.	Other: Standard ACLS Training; Standard didactic interactive session on Advanced Cardiac Life Support (ACLS) principles.
Experimental: Intervention; Subjects allocated to the intervention arm will receive education on crisis resource management (CRM) and teaching targeting the cognitive skills required to monitor and challenge a superior's decision, and conflict resolution tools, in addition to standard didactic interactive session on Advanced Cardiac Life Support (ACLS) principles.	Other: Crisis Resource Management Skill Training; Focused crisis resource management training which targets at the cognitive skills needed to monitor and challenge a superior's decision.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Effect of a teaching intervention on participants' ability to challenge clearly wrong decisions by a superior during a simulated life-threatening crisis	Comparison of the best modified Advocacy-Inquiry Score (mAIS) responses of the 6 challenge opportunities between the intervention and control groups. The mAIS is a modification of the Advocacy-Inquiry method which includes five scoring levels with the addition of a sixth level when a trainee attempts to take over management of the case.	20 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Influence of the confederate's gender on participant's ability to challenge incorrect decisions	Comparison of the median modified Advocacy-Inquiry Score (mAIS) responses between the subjects exposed to male versus female confederate specialist. The mAIS is a modification of the Advocacy-Inquiry method which includes five scoring levels with the addition of a sixth level when a trainee attempts to take over management of the case.	20 minutes

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Qualitative analysis of themes surrounding hierarchy and challenging authority	Themes elicited during open disclosure and discussion during debrief session with participants	10 minutes

Collaborators and Investigators

• Sponsor: National University Hospital, Singapore
• Investigators: Principal Investigator: Gene Chan, MBBS, National University Hospital, Singapore

Study record dates

Study Major Dates

• Study Start (Actual): March 11, 2019
• Primary Completion (Actual): September 20, 2020
• Study Completion (Actual): November 20, 2020

Study Registration Dates

• First Submitted: October 12, 2018
• First Submitted That Met QC Criteria: October 15, 2018
• First Posted (Actual): October 16, 2018

Study Record Updates

• Last Update Posted (Actual): March 3, 2021
• Last Update Submitted That Met QC Criteria: March 2, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Keywords: Medical Education; Simulation; Crisis Resource Management
• Other Study ID Numbers: CRITIQue

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