Data Driven Competitive Motivation Strategies in a Longitudinal Simulation Curriculum for Trauma Team Training.

Mitrou N, Elzinga J, Cheng J, Dobrin A, Uppal CM, Leeper TJ, Aguilar AB, Leeper WR.

J Surg Educ. 2019 Jul - Aug;76(4):1122-1130. doi: 10.1016/j.jsurg.2019.01.004.


OBJECTIVE: A novel approach to trauma team simulation was used to enhance team performance in a cohort of general surgical residents. We implemented data driven debriefing using performance report cards and video footage of the simulations. We wanted to evaluate the technical and nontechnical skills developed by teams using this approach.

DESIGN: All surgical residents in an academic program were divided into 5 equal "trauma teams". Throughout the academic year, each team took part in 4 standardized, high fidelity trauma simulations. Rubrics to assess technical efficiency were scored. Each team received individualized feedback in the form of report cards following each simulation. Video recordings of each simulation were analyzed by blinded raters using a validated instrument to assess nontechnical skills/Crisis Resource Management (CRM) skills.

SETTING: An academic level 1 trauma hospital in Canada.

RESULTS: Five teams comprising five residents participated in four simulations each. Learner feedback was universally positive and learning during simulation was rated higher than learning during didactic lecture. The effect of data driven report cards and anonymized ranking was cited by trainees as a motivating factor to improve. CRM scores improved over the course of the academic year for all teams but without reaching statistical significance. A strong positive correlation was measured between technical and CRM skills for all teams.

CONCLUSIONS: Adding data driven debriefing using performance report cards that assess both technical and CRM skills to a trauma team curriculum is a feasible and acceptable way to influence trainee performance using positive competitive motivation. More data are required to confirm the early patterns of improvement uncovered in CRM scoring. A positive correlation between technical skills and CRM skills raises important questions for future research.

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