Prospective Randomized Controlled Trial of Video- Versus Recall-Assisted Reflection in Simulation-Based Teaching on Acquisition and Retention of Airway Skills Among Trainees Intubating Critically Ill Patients

Crit Care Med. 2020 Sep;48(9):1265-1270. doi: 10.1097/CCM.0000000000004448.

Abstract

Objectives: Conventionally, simulation-based teaching involves reflection on recalled events (recall-assisted reflection). Instead of recall, video-assisted reflection may reduce recall bias and improve skills retention by contributing to visual memory. Here, we test the hypothesis that when compared with recall, video-assisted reflection results in higher acquisition and retention of skills involved in airway management among junior critical care doctors.

Design: Randomized control trial. Participants were randomized 1:1 to video-assisted reflection or recall-assisted reflection group.

Setting: University-affiliated tertiary care center.

Subjects: Junior critical care doctors.

Intervention: Video-assisted reflection.

Measurements and main results: All participants underwent simulation-based teaching of technical and nontechnical airway skills involved in managing a critically ill patient. These skills were assessed before, post-workshop, and in the following fourth week, by two independent blinded assessors using a validated scoring tool. Quality of debrief was assessed using a validated questionnaire. Repeated-measures analysis of variance was used to assess time and group interaction. Forty doctors were randomized. At baseline, the groups had similar airway experience (p = 0.34) and skill scores (p = 0.97). There was a significant interaction between study groups and changes over time for total skill scores (F[2, 37] = 4.06; p = 0.02). Although both the study groups had similar and significant improvement in total skills scores at the postworkshop assessment, the decline in total skills scores at delayed assessment (F[1, 38] = 5.64; p = 0.02) was significantly more in the recall-assisted reflection group when compared with the video-assisted reflection group. This resulted in lower mean skill scores in the recall-assisted reflection group when compared with the video-assisted reflection group in the delayed assessment (89.45 [19.32] vs 110.10 [19.54]; p < 0.01). Better retention was predominantly in the nontechnical skills. The perceived quality of debrief was similar between the two groups.

Conclusion: When compared with recall, video-assisted reflection resulted in similar improvement in airway skills, but better retention over time.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Competence
  • Cognition
  • Critical Illness
  • Female
  • Formative Feedback
  • Group Processes
  • Humans
  • Internship and Residency / organization & administration*
  • Intubation, Intratracheal / methods*
  • Leadership
  • Male
  • Memory, Short-Term*
  • Prospective Studies
  • Simulation Training / organization & administration*
  • Time Factors
  • Video Recording*