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. 2014 Jun;61(6):571-82.
doi: 10.1007/s12630-014-0143-8. Epub 2014 Mar 25.

Transfer of learning and patient outcome in simulated crisis resource management: a systematic review

Sylvain Boet  1 , M Dylan Bould, Lillia Fung, Haytham Qosa, Laure Perrier, Walter Tavares, Scott Reeves, Andrea C Tricco
Affiliations

Transfer of learning and patient outcome in simulated crisis resource management: a systematic review

Sylvain Boet et al. Can J Anaesth. 2014 Jun.

Abstract
in English, French

Purpose: Simulation-based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management (CRM). This systematic review was conducted to gain a better understanding of the impact of simulation-based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes.

Source: Studies on CRM, crisis management, crew resource management, teamwork, and simulation published up to September 2012 were searched in MEDLINE(®), EMBASE™, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC. All studies that used simulation-based CRM teaching with outcomes measured at Kirkpatrick Level 3 (transfer of learning to the workplace) or 4 (patient outcome) were included. Studies measuring only learners' reactions or simple learning (Kirkpatrick Level 1 or 2, respectively) were excluded. Two authors independently reviewed all identified titles and abstracts for eligibility.

Principal findings: Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation-based CRM learning into the clinical setting (Kirkpatrick Level 3). In three of these studies, simulation-enhanced CRM training was found significantly more effective than no intervention or didactic teaching. Five studies measured patient outcomes (Kirkpatrick Level 4). Only one of these studies found that simulation-based CRM training made a clearly significant impact on patient mortality.

Conclusions: Based on a small number of studies, this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality.

Objectif: L’apprentissage basé sur des simulations est de plus en plus utilisé par les professionnels de santé comme méthodes sécuritaires d’apprentissage et de pratique de compétences non techniques, comme la communication et le leadership, qui sont nécessaires pour une gestion efficace des ressources en situation de crise (CRM). Cette étude systématique a été menée pour mieux comprendre l’impact de l’enseignement à partir de simulations de la CRM sur le transfert des connaissances sur le lieu de travail et les changements ultérieurs sur l’évolution des patients.

Source: Les études sur la CRM, gestion de crise, gestion de ressources d’équipes, travail d’équipe et simulation, publiées jusqu’en septembre 2012 ont été recherchées dans les bases de données MEDLINE®, EMBASE™, CINAHL, Cochrane Central Register of Controlled Trials et ERIC. Toutes les études utilisant un enseignement de la CRM à partir de simulations avec des résultats mesurés au niveau 3 de Kirkpatrick (transfert de l’apprentissage au milieu de travail) ou au niveau 4 (évolution du patient) ont été incluses. Toutes les études ne mesurant que les réactions des apprenants ou le seul apprentissage (respectivement, niveau 1 ou 2 de Kirkpatrick) ont été exclues. Deux auteurs ont revu de façon indépendante tous les titres et résumés identifiés pour évaluer leur admissibilité.

Constatations principales: Neuf articles répondant aux critères d’inclusion ont été identifiés. Quatre études mesuraient le transfert d’apprentissage de la CRM à partir de simulations vers un cadre clinique (niveau 3 de Kirkpatrick). Dans trois de ces études, la formation à la CRM soutenue par des simulations s’est avérée significativement plus efficace que l’absence d’intervention ou un enseignement didactique. Cinq études mesuraient les résultats pour les patients (niveau 4 de Kirkpatrick). Une seule de ces études a trouvé que la formation à la CRM basée sur des simulations avait un impact clairement significatif sur la mortalité des patients.

Conclusions: Reposant sur un petit nombre d’études, cette analyse systématique a trouvé que les habiletés en matière de CRM apprises au centre de simulations sont transférées dans des cadres cliniques et que les habiletés acquises de CRM peuvent se traduire par une amélioration de l’évolution, y compris une baisse de la mortalité.

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Figures

Fig. 1
Fig. 1
Search and selection of included studies. *Languages other than English or French considered as Foreign Language
Fig. 2
Fig. 2
Risk of bias summary. Other biases include large inter-rater reliability of 0.2 for part II outcome assessments and sampling bias. Green = low risk; yellow = intermediate risk or unclear; red = high risk
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