Crisis Resource Management Improvement Through Intellectual Questioning of Authority

NCT03707964 | Completed DMC

• 1 other identifier: CRITIQue
• Study Type: interventional
• Target: 25
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Medical Education, Simulation, Crisis Resource Management

Keywords

Medical Education; Simulation; Crisis Resource Management

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (1)

• Influence of the confederate's gender on participant's ability to challenge incorrect decisions

  20 minutes

Other Outcomes (1)

• Qualitative analysis of themes surrounding hierarchy and challenging authority

  10 minutes

Study Arms (2)

Control

PLACEBO COMPARATOR

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

Intervention

EXPERIMENTAL

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

Interventions

Crisis Resource Management Skill Training OTHER

Focused crisis resource management training which targets at the cognitive skills needed to monitor and challenge a superior's decision.

Intervention

Standard ACLS Training OTHER

Standard didactic interactive session on Advanced Cardiac Life Support (ACLS) principles.

Control

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

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

Sponsors & Collaborators

• National University Hospital, Singapore: lead

Study Sites (1)

National University Hospital, Singapore

Singapore, 119085, Singapore

Location

Study Officials

• Gene Chan, MBBS

  National University Hospital, Singapore

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Masking Details: Deliberate deception (by not informing of the aim of assessing for ability to challenge authority) will be used to blind the participants. However, open disclosure and explanation of the rationale for deception will be conducted during the debriefing sessions and participants will be extensively counselled. The confederate specialist will also be blinded to the allocation of the control or intervention arm of participants. All sessions will be video recorded and assessed in random order by two independent raters blinded to group allocation, using the modified Advocacy-Inquiry Score (mAIS).
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 12, 2018
• First Posted: October 16, 2018
• Study Start: March 11, 2019
• Primary Completion: September 20, 2020
• Study Completion: November 20, 2020
• Last Updated: March 3, 2021

Record last verified: 2021-03

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)