Proficiency-Based Progression Training for Clinical Communication

The Effect of a Proficiency Based Progression Training Programme for Clinical Communication on ISBAR Performance

Importance: Clinical communication is an important source of medical error and preventable adverse events. Objective: To determine the effectiveness of proficiency-based progression (PBP) simulation training for ISBAR (Identify, Situation, Background, Assessment, Recommendation) communication in the deteriorating patient. Setting: The study will be conducted in University College Cork, Ireland. Participants: Third year undergraduate nursing and fifth year medical students, who are scheduled to undertake ISBAR training as part of the National Early Warning Score (NEWS) programme. Intervention: Participants will be prospectively randomized to one of three groups before undertaking a performance assessment of an ISBAR communication relevant to a deteriorating patient in a high fidelity simulation laboratory: HSE group (the national e-learning programme only); S group (national e- learning plus simulation training) and PBP group (national e-learning plus proficiency-based progression simulation). Main outcome and measures: A proficiency benchmark on the performance of ISBAR communication in the context of an acutely deteriorating patient.

The first successful simulation validation study used a proficiency-based progression methodology. Since then the approach has been successfully deployed to produce superior technical skills but has not yet been validated for non-technical (communication) skills. The ISBAR (Identify, Situation, Background, Assessment and Recommendation) has been selected as the standardised tool for clinical communication in relation to an acutely deteriorating patient in many healthcare organisations worldwide, including Ireland. The aim of this study is to explore whether proficiency-based progression (PBP) could be applied to simulation-based training for ISBAR performance to produce a superior skill set. The study will compare performance outcomes of students, who receive the national e-learning programme only with those who receive it in combination with either standard simulation or proficiency-based progression (PBP) simulation. Participants will be prospectively randomized to one of three training groups within their professional cohort (medicine or nursing) before undertaking a performance assessment of an ISBAR communication relevant to a deteriorating patient in a high fidelity simulation laboratory: Online learning only (HSE) -the national e-learning programme only Standard simulation (S) -online learning plus simulation training Proficiency based progression (PBP) -online learning plus proficiency-based progression simulation. Main outcome and measures: A proficiency benchmark on the performance of ISBAR communication in the context of an acutely deteriorating patient. All participants will be required to demonstrate a certificate of successful completion on the national e-learning programme within the previous 4 weeks as well as supplying baseline demographic information before undertaking the training. Performance metrics have previously been identified, operationally defined and agreed upon at a modified Delphi panel meeting consisting of medical and nursing experts for a series of paper-based simulation cases and a standardised high fidelity simulation case used as the assessment case. The proficiency benchmark for each case has been set based on the performance of experienced nursing and medical personnel on each case as a series of steps, errors and critical errors. Outcome assessment will be scored by reviewing recordings of ISBAR performance by each participant on the standardised case in the high fidelity laboratory.

Clinical Communication, ISBAR, Simulation, Proficiency-Based Progression, Non Technical Skills, Performance, Deteriorating Patient

National e-learning programme only Recent successful completion the National e-learning programme by certificate will be displayed. Students then complete a student satisfaction survey and proceed directly for performance assessment to the high-fidelity simulation suite.

Simulation Recent successful completion of the National e-learning e-learning programme by certificate will be displayed. Students will proceed to standard simulation using the same series of paper cases as PBP which prompt simulated phone calls but no requirement to meet a proficiency benchmark. 4 hours will be allotted to this training. Following training participants will complete the student satisfaction survey and will then proceed directly for performance assessment to the high-fidelity simulation suite.

Recent successful completion of the National e-learning programme by certificate will be displayed. Students will proceed to PBP simulation using the same series of paper cases as S which prompt simulated phone calls. PBP students will be scored according to predefined metrics and will be required to reach proficiency benchmarks. Following training participants will complete the student satisfaction survey and proceed directly for performance assessment to the high-fidelity simulation suite.

Independent review by two blinded assessors of recorded ISBAR phone call conducted in the high fidelity simulation setting

Inclusion Criteria: Third year undergraduate nursing students Fifth year medical students Exclusion Criteria: Lack of consent Failure to successfully complete the National e-learning NEWS programme

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