Colleen Bush

A Randomized Trial of SMART Goal Enhanced Debriefing after Simulation to Promote Educational Actions

Introduction Goal setting is used in education to promote learning and performance. Debriefing after clinical scenario-based simulation is a well-established practice that provides learners a defined structure to review and improve performance. Our objective was to integrate formal learning goal generation, using the SMART framework (Specific, Measurable, Attainable, Realistic, and Time-bound), into standard debriefing processes (i.e., “SMART Goal Enhanced Debriefing”) and subsequently measure the impact on the development of learning goals and execution of educational actions. Methods This was a prospective multicenter randomized controlled study of 80 emergency medicine residents at three academic hospitals comparing the effectiveness of SMART Goal Enhanced Debriefing to a standard debriefing. Residents were block randomized on a rolling basis following a simulation case. SMART Goal Enhanced Debriefing included five minutes of formal instruction on the development of SMART learning goals during the summary/application phase of the debrief. Outcome measures included the number of recalled learning goals, self-reported executed educational actions, and quality of each learning goal and educational action after a two-week follow-up period. Results The mean number of reported learning goals was similar in the standard debriefing group (mean 2.05 goals, SD 1.13, n=37 residents), and in the SMART Goal Enhanced Debriefing group (mean 1.93, SD 0.96, n=43), with no difference in learning goal quality. Residents receiving SMART Goal Enhanced Debriefing completed more educational actions on average (Control group actions completed 0.97 (SD 0.87), SMART debrief group 1.44 (SD 1.03) p=0.03). Conclusion The number and quality of learning goals reported by residents was not improved as a result of SMART Goal Enhanced Debriefing. Residents did, however, execute more educational actions, which is consistent with the overarching intent of any educational intervention.

Comparative analysis of five methods of emergency zipper release by experienced versus novice clinicians.

The entrapment of penile tissue (foreskin, shaft, or glans) within the actuator or teeth of a zipper accounts for one of the most common genital injuries in young boys [1]. Literature suggests that zipper injuries are relatively uncommon, and that localized edema and pain are the most common outcomes, with significant injury such as skin loss and necrosis occurring rarely [1,2]. The purpose of our studywas to compare five common techniques for releasing zipper-entrapped skin using an animal model. This was a prospective, randomized trial using an animal model consisting of chicken skin firmly entrapped by a metal zipper on a pair of denim jeans. Volunteers consisted of 12 Emergency Medicine (EM) physician faculty and 18 medical students (novice clinicians). During the simulation lab, participants were taught the five common techniques for releasing zipper-entrapped skin: 1) cutting the median bar, 2) using a screwdriver to separate faceplates, 3) manipulation of the zipper using mineral oil lubricant, 4) lateral compression of the zip fastener using pliers, and 5) removal of teeth of the zip mechanism using trauma scissors [2-6]. The order in which the techniques were performed by each volunteer was chosen by a random number generator. Subjects were timed by evaluators using a digital stopwatch from the time they began until the successful release of the entrapped skin, or for five minutes, whichever came first. Success was defined as the release of the entrapped skinwhileminimizing trauma to the skin. Failure to successfully release the skinwithin fiveminutes, or causing full thickness laceration to the skin, were logged as failures.