Effect of a proficiency-based progression simulation programme on clinical communication for the deteriorating patient: a randomised controlled trial

Dorothy Breen, Sinead O'Brien, Nora McCarthy, Anthony Gallagher, Nuala Walshe, Dorothy Breen, Sinead O'Brien, Nora McCarthy, Anthony Gallagher, Nuala Walshe

Abstract

Objective: This study aimed to determine the effectiveness of a proficiency-based progression (PBP) training approach to clinical communication in the context of a clinically deteriorating patient.

Design: This is a randomised controlled trial with three parallel arms.

Setting: This study was conducted in a university in Ireland.

Participants: This study included 45 third year nursing and 45 final year medical undergraduates scheduled to undertake interdisciplinary National Early Warning Score (NEWS) training over a 3-day period in September 2016.

Interventions: Participants were prospectively randomised to one of three groups before undertaking a performance assessment of the ISBAR (Identification, Situation, Background, Assessment, Recommendation) communication tool relevant to a deteriorating patient in a high-fidelity simulation facility. The groups were as follows: (i) E, the Irish Health Service national NEWS e-learning programme only; (ii) E+S, the national e-learning programme plus standard simulation; and (iii) E+PBP, the national e-learning programme plus PBP simulation.

Main outcome measures: The primary outcome was the proportion in each group reaching a predefined proficiency benchmark comprising a series of predefined steps, errors and critical errors during the performance of a standardised, high-fidelity simulation assessment case which was recorded and scored by two independent blinded assessors.

Results: 6.9% (2/29) of the E group and 13% (3/23) of the E+S group demonstrated proficiency in comparison to 60% (15/25) of the E+PBP group. The difference between the E and the E+S groups was not statistically significant (χ2=0.55, 99% CI 0.63 to 0.66, p=0.63) but was significant for the difference between the E and the E+PBP groups (χ2=22.25, CI 0.00 to 0.00, p<0.000) and between the E+S and the E+PBP groups (χ2=11.04, CI 0.00 to 0.00, p=0.001).

Conclusions: PBP is a more effective way to teach clinical communication in the context of the deteriorating patient than e-learning either alone or in combination with standard simulation.

Trial registration number: NCT02886754; Results.

Keywords: assessment; communication; handover; performance; safety; simulation.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Consort diagram outlining selection, allocation and follow-up of undergraduate medical and nursing participants in a study comparing the effect of e-learning alone (E), e-learning plus standard simulation (E+S) and e-learning plus proficiency-based progression simulation (E+PBP) on clinical communication. NEWS, National Early Warning Score.
Figure 2
Figure 2
Outline of experimental design and study flow indicating training interventions and assessment of the three study training groups (E, E+S, E+PBP) of undergraduate medical and nursing participants. ISBAR, Identification, Situation, Background, Assessment, Recommendation; NEWS, National Early Warning Score.
Figure 3
Figure 3
Outline of the high-fidelity simulation performance assessment case for nursing undergraduates.
Figure 4
Figure 4
Extract from the nursing metric scoring sheet illustrating some of the metrics and the proficiency benchmark for the high-fidelity simulation assessment case.
Figure 5
Figure 5
The percentages reaching the proficiency benchmark at the end of training of the three study training groups: e-learning alone (E), e-learning plus standard simulation training (E+S) and e-learning plus proficiency-based progression simulation training (E+PBP).
Figure 6
Figure 6
Logistic regression analysis for the relative differences between the three study training groups of undergraduate medical and nursing participants: e-learning alone (E), e-learning plus standard simulation training (E+S) and e-learning plus proficiency-based progression simulation training (E +PBP).

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