Optimizing training designs and elevating reporting standards in simulation-based medical education

Abstract

Introduction: This thesis explores key elements of simulation-based education for healthcare professionals, focusing on protocol reporting, technical skill retention/transfer, and training microstructures. Study 1 developed and assessed new protocol reporting and evaluation tools (PRT and PET) to measure the quality of reporting (QOR) in simulation studies. Using a modified Delphi method, the PRT and PET were created and applied alongside the TIDieR Checklist and CONSORT Statement to evaluate 17 randomized controlled trials. Results revealed significant differences in QOR scores across the tools, highlighting strengths and areas for improvement in reporting practices. The PRT and PET have the potential to enhance QOR, enable accurate study replication, and assist in the identification of optimal training designs. Study 2 examined the long-term impact of a simulation-based mastery learning (SBML) curriculum versus a competency-based curriculum on pediatric emergency medicine (PEM) physicians’ video laryngoscopy (VL) skill retention and transfer six months post-training. A multidisciplinary panel set a minimum passing score (MPS) of 32/36 (89%) using the Mastery Angoff method. The mastery group outperformed the competency group in skill retention and transfer, suggesting that SBML better sustains VL skills amongst PEM physicians. Study 3 analyzed the microstructures of competency-based and mastery-based training interventions for VL. Behavior coding software determined that mastery learners took longer to reach their MPS, engaged in more partial versus whole practice trials, spent more time verbalizing preparatory steps and aftercare plans, and received more feedback from their instructor compared to learners in the competency group. These differences likely contributed to differences in VL skill learning, as observed in Study 2. Conclusions: This thesis emphasizes the importance of the microstructure in simulation-based training interventions. Detailed and accurate reporting and evaluation of training microstructures is necessary for the advancement of the field, and the newly developed PRT and PET provide a means to do so. The microstructure of the SBML intervention more effectively facilitated VL skill learning, compared to the competency-based intervention. These findings offer valuable insights for educators, researchers, and program facilitators in medical education.