1. ALERT Presentation: The effect of
resident fatigue on simulation
training outcomes
Ashley L. Flannery, DO, Neeraja Kairam, MD, Hetal Patel, MD,
David Salo, MD, PhD
Morristown Medical Center
INSPIRE @ IMSH 2014: San Francisco, California,USA
International Network for Simulation-based Pediatric Innovation, Research and Education
2. Background
• 2012 NEJM report examined resident physician
duty hour restrictions
• However there is a lack of evidence to support
these claims
International Network for Simulation-based Pediatric Innovation, Research and Education
3. Background
• What we do know:
– Simulation is an effective tool in assessing the
knowledge and skills of resident physicians
International Network for Simulation-based Pediatric Innovation, Research and Education
4. PICO Question
• P: Emergency Medicine (EM) residents
• I: Fatigue
• C: pre day shift and post night shift (12 hours)
• O: number of critical outcomes achieved
International Network for Simulation-based Pediatric Innovation, Research and Education
5. Approach / Design
• Sample of 16 EM residents, PGY1-3
– One simulation at start of 12 hour day shift
– One simulation at conclusion of 12 hour night shift
– Washout period of 12 weeks between simulations
International Network for Simulation-based Pediatric Innovation, Research and Education
6. Approach / Design
• Simulation scenario: pediatric septic shock
– Two cases with altered HPIs
– Same critical actions to be performed.
• Assessment
– Performance assessment tool
• measure completion of clinically appropriate interventions
– Record duration of time to complete tasks
International Network for Simulation-based Pediatric Innovation, Research and Education
7. Approach / Design
• Subjects will be analyzed
– Paired statistical testing
– Cross-over model
• half of the subjects starting the protocol under increased
fatigue (post night shift)
• half of the subjects in a non-fatigue situation (day shift)
International Network for Simulation-based Pediatric Innovation, Research and Education
8. Timeline
• IRB approval received- October 2013
• ALERT Presentation- January 2014
• Recruitment / Data Collection- January and April 2014
• Data Analysis
• Abstract Presentation
• Manuscript Preparation
International Network for Simulation-based Pediatric Innovation, Research and Education
9. 3 Questions to improve study
1.
Is the number of residents sufficient to see a true difference?
2.
We are using the same case twice with slight variations in the HPI.
Even with the washout period, it may lead to improved scores on
second simulation. Is there a way to control for that?
3.
Will this study be able to be used as a stepping point to determine
if 8 hr vs 12 hr shifts are better or to limit consecutive shifts?
International Network for Simulation-based Pediatric Innovation, Research and Education
