This document discusses a study that aims to evaluate whether simulation-based training is an effective method for acquiring clinical reasoning skills in neonatology compared to traditional classroom training. The study will involve randomly assigning pediatric residents and neonatology fellows to either a simulation group or traditional training group. Both groups will complete pre- and post-tests involving multiple choice questions, script concordance tests, and clinical reasoning problem assessments to evaluate their clinical reasoning performance before and after their assigned training method. The researcher is seeking advice from INSPIRE on aspects of the study design such as whether a pre-test is necessary, how many topics should be covered in the training, and whether resources should be provided to participants.

1. Is simulation-based training an
effective method for the
acquisition of clinical reasoning
in neonatology ?
Thomas Pennaforte
CHU Sainte-Justine, Montreal, Canada
IMSH 2014: San Francisco, CA / USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. Background 1
• Simulation in neonatology : Neonatal Resuscitation Program
 cognitive, technical & behavioral skills
• Complex situations in NICU
No guidelines, context of uncertainty
 clinical reasoning
International Network for Simulation-based Pediatric Innovation, Research and Education

3. Background 2
ASSESSMENT TOOLS
Factual knowledge
Data identification
Reasoning
Process
MCQ
Script Concordance Tests
Data interpretation
Clinical Reasoning
Hypothesis generation
Clinical Reasoning Problem
Key Feature Problem
Decision making
International Network for Simulation-based Pediatric Innovation, Research and Education

4. The PICO question
• Population
Pediatric residents and neonatology fellows
• Intervention
Simulation-based training
• Comparison
Traditional classroom training
• Outcome
Clinical reasoning peformance
International Network for Simulation-based Pediatric Innovation, Research and Education

5. Design
Pre-Test
MCQ, SCT, CDM, CRP
Randomization
TRAD group
SIM group
n=25
n=25
Post-Test
MCQ, SCT, CDM, CRP
Retesting
International Network for Simulation-based Pediatric Innovation, Research and Education

6. Timeline
• Jan. and Feb 2014 : test’s construction
• March 2014 : evaluation of test’s interest by students from
others universities
• May 2014 : Pilot study with French participants
• Mid 2014 : Final study with Canadian participants
• Data analysis, article redaction and submission
International Network for Simulation-based Pediatric Innovation, Research and Education

7. Need INSPIRE help !
• Is a Pre-Test necessary ?
• How many topics should be covered?
– One topic = 60 min PPT vs 2 topics = 120 min !
• Simulation training ?
– One scenario (1 hr) vs. two short (30 min) scenarios ?
– If 2 scenarios: repeat scenario or 2 different scenarios
• Should scientific resources be given to participants ? Both
groups? At what time?
International Network for Simulation-based Pediatric Innovation, Research and Education

8. Contact Information
Thomas PENNAFORTE
CHU Sainte-Justine
Montreal, Canada
thomas@pennaforte.net
International Network for Simulation-based Pediatric Innovation, Research and Education

9. Script Concordance Tests
1. Short clinical scenario
Always incorporate uncertainty. Several options are relevant to solve
the diagnostic or management problem posed by the situation.
2. Questions in three parts
1. "if you were thinking of" contains a relevant diagnostic or
management option
2. "and then you were to find" presents a new clinical finding, such
as a physical sign, a pre-existing condition, an imaging study or
a laboratory test result.
3. "this option would become" is a five-point Likert scale that
captures examinees' decisions.
Data interpretation
International Network for Simulation-based Pediatric Innovation, Research and Education

10. Clinical Reasoning Problems
1. Short clinical scenario
Patient presentation, history and physical examination
2. Questions
1. What do you think is the most likely diagnosis in this patient?
2. List the features of the case which you consider support your
diagnosis and also those which oppose it, giving an appropriate sign
[positive (+) or negative (-)] and weighting to each.
3. If this diagnosis proved incorrect, what would your next choice
be?
4. List the features of the case which you consider support your
diagnosis and also those which oppose it, giving an appropriate sign
[positive (+) or negative (-)] and weighting to each.
Data identification
Data interpretation
Hypothesis generation
International Network for Simulation-based Pediatric Innovation, Research and Education

11. Key Feature Problems
1. Short clinical scenario
Patient presentation, history and physical examination
2. Questions
1. What is your leading diagnosis at this time?
2. What steps will you take in your immediate assessment and
management of this patient ? Select as many as are appropriate
3. …
Data identification
Data interpretation
Hypothesis generation
Decision making
International Network for Simulation-based Pediatric Innovation, Research and Education