Communication Clinical Trial
Official title:
The Effect of an E-learning Proficiency Based Progression Training Programme for Clinical Communication on ISBAR Performance
Objective:
To determine the effectiveness of proficiency based inter-professional communication training
in an online environment on medical student's use of the ISBAR (Identify, Situation,
Background, Assessment, Recommendation) communication escalation protocol in the
deteriorating patient
Setting: The study will be conducted in University College Cork, Ireland. Participants: Fifth
year medical students, who are scheduled to undertake ISBAR training as part of the National
Early Warning Score (NEWS) programme.
Intervention: Participants will be prospectively randomized to one of three groups for
training before undertaking a performance assessment of an ISBAR communication relevant to a
deteriorating patient in a low fidelity simulation environment: HSE group (the national
e-learning programme only); S group (national e- learning plus access to online scenarios and
facilitator when requested) and PBP group (national e-learning plus access to online
scenarios training course with in-built proficiency-based progression, and facilitator when
requested).
Main outcome and measures: A proficiency benchmark on the performance of ISBAR communication
in the context of an acutely deteriorating patient.
The first successful simulation validation study used a proficiency-based progression
methodology. Since then the approach has been successfully deployed to produce superior
technical skills but has not yet been validated for non-technical (communication) skills. It
has also not yet been validated through the medium of virtual learning. The ISBAR (Identify,
Situation, Background, Assessment and Recommendation) has been selected as the standardised
tool for clinical communication in relation to an acutely deteriorating patient in many
healthcare organisations worldwide, including Ireland.
The aim of this study is to explore whether proficiency-based progression (PBP) could be
applied to an e-learning training course for ISBAR performance to produce a superior skill
set.
The study will compare performance outcomes of students who receive the national e-learning
programme only with those who receive it in combination with either standard e-learning
course with scenarios or proficiency-based progression (PBP) e-learning course with
scenarios.
Participants will be prospectively randomized to one of three training groups. Following a
pre-test observation through low-fidelity simulation, they will then undergo their respective
training courses before undertaking a post-test performance assessment of an ISBAR
communication relevant to a deteriorating patient in a low fidelity simulation environment:
1. Online learning only (HSE) -the national e-learning programme only
2. Scenarios (S) -national online learning plus online scenario course training
3. Proficiency based progression (PBP) -national online learning plus proficiency-based
progression online scenario course training.
Main outcome and measures: A proficiency benchmark on the performance of ISBAR communication
in the context of an acutely deteriorating patient.
All participants will be required to supply baseline demographic information before
undertaking the training.
Performance metrics have previously been identified, operationally defined and agreed upon at
a modified Delphi panel meeting consisting of medical experts for a series of paper-based
simulation cases and a standardised high fidelity simulation case used as the assessment
case. This case will be used in this study in a low fidelity environment. The proficiency
benchmark for each case has been set based on the performance of experienced medical
personnel on each case as a series of steps, errors and critical errors.
Outcome assessment will be scored by reviewing auditory recordings of ISBAR performance by
each participant on the standardised case in the low fidelity simulated environment.
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