Impact of Simulation Training on Undergraduate Clinical Decision-making in Emergencies: A Non-blinded, Single-centre, Randomised Pilot Study

Introduction: There is an increasing evidence base for the use of simulation-based medical education. Simulation is superior to more didactic methods for teaching a range of technical and non-technical skills, and students report they often derive more educational value from it compared with other teaching methods. There is currently limited evidence that simulation training improves clinical decision-making and, therefore, this pilot study sought to explore this further. Methods: Students were randomised to take part in either five classroom tutorials and simulation training sessions or five classroom tutorials and an online e-learning module. On completion of the teaching, students all undertook an unseen assessment scenario (managing a simulated patient with anaphylaxis), where they were scored using a weighted marking scheme. The time taken to make decisions and student-reported confidence in decisions were also measured. Results: 14/14 simulation-group participants and 12/14 e-learning-group participants completed the post-learning assessment. The simulation group identified anaphylaxis and gave adrenaline more quickly (p 0.008 and 0.005, respectively), and this cohort was more confident in making the diagnosis (p 0.044). There was no statistically significant difference between weighted global assessment scores for each group (p 0.705). The e-learning group called for help more quickly (p.0.049), although fewer students in this group called for help (five vs. nine). There was no statistical difference in confidence in decisions to administer adrenaline or call for help (p 0.539 and 0.364 respectively). Conclusions: Participants who undertook simulation training were able to more confidently and quickly identify the diagnosis and initiate emergency treatment. However, there was not a statistically significant difference between groups using an overall weighted score. Using simulation to train students to perform better in emergencies and improve their decision-making shows promise but a further quantitative study is required.