Testing the validity of three acute care assessment tools for assessing residents' performance during in situ simulation: the ACAT-SimSit study.

BACKGROUND: The assessment of technical and nontechnical skills in emergency medicine requires reliable and usable tools. Three Acute Care Assessment Tools (ACATs) have been developed to assess medical learners in their management of cardiac arrest (ACAT-CA), coma (ACAT-coma) and acute respiratory failure (ACAT-ARF). OBJECTIVE: This study aims to analyze the reliability and usability of the three ACATs when used for in situ (bedside) simulation. METHODS: This prospective multicenter validation study tested ACATs using interprofessional in situ simulations in seven emergency departments and invited training residents to participate in them. Each session was rated by two independent raters using ACAT. Intraclass correlation coefficients (ICC) were used to assess interrater reliability, and Cronbach's alpha coefficient was used to assess internal consistency for each ACAT. The correlation between ACATs' scores and the learners' level of performance was also assessed. Finally, a questionnaire and two focus groups were used to assess the usability of the ACATs. RESULTS: A total of 104 in situ simulation sessions, including 85 residents, were evaluated by 37 raters. The ICC for ACAT-CA, ACAT-coma and ACAT-ARF were 0.95 [95% confidence interval (CI), 0.93-0.98], 0.89 (95% CI, 0.77-0.95) and 0.92 (95%CI 0.83-0.96), respectively. The Cronbach's alphas were 0.79, 0.80 and 0.73, respectively. The ACAT-CA and ARF showed good construct validity, as third-year residents obtained significantly higher scores than first-year residents (P < 0.001; P < 0.019). The raters supported the usability of the tools, even though they expressed concerns regarding the use of simulations in a summative way. CONCLUSION: This study reported that the three ACATs showed good external validity and usability.

Strategies to safely rule out pulmonary embolism in COVID-19 outpatients: a multicenter retrospective study.

OBJECTIVES: The objective was to define a safe strategy to exclude pulmonary embolism (PE) in COVID-19 outpatients, without performing CT pulmonary angiogram (CTPA). METHODS: COVID-19 outpatients from 15 university hospitals who underwent a CTPA were retrospectively evaluated. D-Dimers, variables of the revised Geneva and Wells scores, as well as laboratory findings and clinical characteristics related to COVID-19 pneumonia, were collected. CTPA reports were reviewed for the presence of PE and the extent of COVID-19 disease. PE rule-out strategies were based solely on D-Dimer tests using different thresholds, the revised Geneva and Wells scores, and a COVID-19 PE prediction model built on our dataset were compared. The area under the receiver operating characteristics curve (AUC), failure rate, and efficiency were calculated. RESULTS: In total, 1369 patients were included of whom 124 were PE positive (9.1%). Failure rate and efficiency of D-Dimer > 500 µg/l were 0.9% (95%CI, 0.2-4.8%) and 10.1% (8.5-11.9%), respectively, increasing to 1.0% (0.2-5.3%) and 16.4% (14.4-18.7%), respectively, for an age-adjusted D-Dimer level. D-dimer > 1000 µg/l led to an unacceptable failure rate to 8.1% (4.4-14.5%). The best performances of the revised Geneva and Wells scores were obtained using the age-adjusted D-Dimer level. They had the same failure rate of 1.0% (0.2-5.3%) for efficiency of 16.8% (14.7-19.1%), and 16.9% (14.8-19.2%) respectively. The developed COVID-19 PE prediction model had an AUC of 0.609 (0.594-0.623) with an efficiency of 20.5% (18.4-22.8%) when its failure was set to 0.8%. CONCLUSIONS: The strategy to safely exclude PE in COVID-19 outpatients should not differ from that used in non-COVID-19 patients. The added value of the COVID-19 PE prediction model is minor. KEY POINTS: • D-dimer level remains the most important predictor of pulmonary embolism in COVID-19 patients. • The AUCs of the revised Geneva and Wells scores using an age-adjusted D-dimer threshold were 0.587 (95%CI, 0.572 to 0.603) and 0.588 (95%CI, 0.572 to 0.603). • The AUC of COVID-19-specific strategy to rule out pulmonary embolism ranged from 0.513 (95%CI: 0.503 to 0.522) to 0.609 (95%CI: 0.594 to 0.623).

Effect of a specific training intervention with task interruptions on the quality of simulated advance life support: A randomized multi centered controlled simulation study.

PURPOSE: Task interruptions (TI) are frequent disturbances for emergency professionals performing advanced life support (ALS). The aim of our study was to evaluate a specific training intervention with TI on the quality of simulated ALS. METHODS: During this multi centered randomized controlled trial, each team included one resident, one nurse and one emergency physician. The teams were randomized for the nature of their training session: control (without interruption) or intervention (with TI). The primary outcome was non-technical skills assessed with the TEAM score. We also measured the no flow time, the Cardiff score and chest compression depth and rate. RESULTS: On a total of 21 included teams, 11 were randomized to a control training session and 10 to the specific TI training. During training, teams' characteristics and skills were similar between the two groups. During the evaluation session, the TEAM score was not different between groups: median score for control group 33,5 vs 31,5 for intervention group. We also report similar no flow time and Cardiff score. CONCLUSION: In this simulated ALS study, a specific training intervention with TI did not improve technical and non-technical skills. Further research is required to limit the impact of TI in emergency settings.

Trauma team leader and early mortality: An interrupted time series analysis.

BACKGROUND: The trauma team leader (TTL) is a "model" of a specifically dedicated team leader in the emergency department (ED), but its benefits are uncertain. The primary objective was to assess the impact of the TTL on 72-hour mortality. Secondary objectives included 24-hour mortality and admission delays from the ED. METHODS: Major trauma admissions (Injury Severity Score (ISS)≥12) in 3 Canadian Level-1 trauma centres were included from 2003 to 2017. The TTL program was implemented in centre 1 in 2005. An interrupted time series (ITS) analysis was performed. Analyses account for the change in patient case-mix (age, sex, and ISS). The two other centres were used as control in sensitivity analyses RESULTS: Among 20,193 recorded trauma admissions, 71.7% (n=14,479) were males. The mean age was 53.5 ± 22.0 years. The median [IQR] ISS was 22 [16-26]. TTL implementation was not associated with a change in the quarterly trends of 72-hour or 24-hour mortality: adjusted estimates with 95% CI were 0.32 [-0.22;0.86] and -0.07 [-0.56;0.41] percentage-point change. Similar results were found for the proportions of patients admitted within 8 hours of ED arrival (0.36 [-1.47;2.18]). Sensitivity analyses using the two other centres as controls yielded similar results. CONCLUSION: TTL implementation was not associated with changes in mortality or admission delays from the ED. Future studies should assess the potential impact of TTL programs on other patient-centred outcomes using different quality of care indicators.

Is in situ simulation in emergency medicine safe? A scoping review.

OBJECTIVES: To provide an overview of the available evidence regarding the safety of in situ simulation (ISS) in the emergency department (ED). DESIGN: Scoping review. METHODS: Original articles published before March 2021 were included if they investigated the use of ISS in the field of emergency medicine. INFORMATION SOURCES: MEDLINE, EMBASE, Cochrane and Web of Science. RESULTS: A total of 4077 records were identified by our search strategy and 2476 abstracts were screened. One hundred and thirty full articles were reviewed and 81 full articles were included. Only 33 studies (40%) assessed safety-related issues, among which 11 chose a safety-related primary outcome. Latent safety threats (LSTs) assessment was conducted in 24 studies (30%) and the cancellation rate was described in 9 studies (11%). The possible negative impact of ISS on real ED patients was assessed in two studies (2.5%), through a questionnaire and not through patient outcomes. CONCLUSION: Most studies use ISS for systems-based or education-based applications. Patient safety during ISS is often evaluated in the context of identifying or mitigating LSTs and rarely on the potential impact and risks to patients simultaneously receiving care in the ED. Our scoping review identified knowledge gaps related to the safe conduct of ISS in the ED, which may warrant further investigation.

Innovating for a Safe Simulation Challenge During a Pandemic: An Avatar Simulation Concept.

SUMMARY STATEMENT: We present a new simulation-based challenge (Sim'Cup) concept, created in response to the COVID-19 pandemic. It took place in 2020, during the European Society of Emergency Medicine and the Societé Française de Médecine d'Urgence (SFMU) conferences. Usually, during the conferences, a Sim'Cup is held with onsite participants who are involved in a consecutive series of face-to-face simulations organized in 2 qualifying rounds, followed by a final round. When congresses were transformed into online events, the Sim'Cup had to evolve into a virtual format as well. We developed the e-Sim'Cup concept as follows: participants staying safely at home, piloting the trainers, as if they were their own avatar, in a simulation room with a full-scale high-fidelity manikin (Gaumard, Laerdal) using real-time scenarios. Participants gave instructions to the avatars through a smartphone and via a website. Each team participated in 2 scenarios. At the end of each scenario, teams had to undergo a self-debriefing, followed by a short debriefing with the organizers. Twenty-seven participants divided into 9 teams participated in 1 of the 2 e-Sim'Cup events.We evaluated the impact of this approach using the Educational Practices Questionnaire, and we also analyzed the participants' perception of their satisfaction and their feelings of improvement with this virtual format. Moreover, we conducted qualitative analyses of the self-debriefings. Thirteen participants filled out the questionnaire, giving a combined high Educational Practices Questionnaire score [72 (66.5-77) of 80], which reflects the presence of educational best practices during the e-Sim'Cups. They appreciated the adjusted Sim'Cup format and believed that they were able to improve their communication, clinical skills, and self-confidence. The qualitative analysis suggested that the approach was perceived as immersive by the 27 participants, with some challenges due to technical problems but an overall feeling of improvement regarding their crisis resource management skills. The hybrid remote simulation concept satisfied the participants who believed that it improved important skills in emergency medicine. The increasing number of remote activities and conferences lead us to believe that our e-Sim'Cup concept can be easily reproducible in any simulation center, as it requires only the application of the educational concept and either the use of the website or the use of some widely available technical devices.

Comparison of Patients Infected With Delta Versus Omicron COVID-19 Variants Presenting to Paris Emergency Departments : A Retrospective Cohort Study.

BACKGROUND: At the end of 2021, the B.1.1.529 SARS-CoV-2 variant (Omicron) wave superseded the B.1.617.2 variant (Delta) wave. OBJECTIVE: To compare baseline characteristics and in-hospital outcomes of patients with SARS-CoV-2 infection with the Delta variant versus the Omicron variant in the emergency department (ED). DESIGN: Retrospective chart reviews. SETTING: 13 adult EDs in academic hospitals in the Paris area from 29 November 2021 to 10 January 2022. PATIENTS: Patients with a positive reverse transcriptase polymerase chain reaction (RT-PCR) test result for SARS-CoV-2 and variant identification. MEASUREMENTS: Main outcome measures were baseline clinical and biological characteristics at ED presentation, intensive care unit (ICU) admission, mechanical ventilation, and in-hospital mortality. RESULTS: A total of 3728 patients had a positive RT-PCR test result for SARS-CoV-2 during the study period; 1716 patients who had a variant determination (818 Delta and 898 Omicron) were included. Median age was 58 years, and 49% were women. Patients infected with the Omicron variant were younger (54 vs. 62 years; difference, 8.0 years [95% CI, 4.6 to 11.4 years]), had a lower rate of obesity (8.0% vs. 12.5%; difference, 4.5 percentage points [CI, 1.5 to 7.5 percentage points]), were more vaccinated (65% vs. 39% for 1 dose and 22% vs. 11% for 3 doses), had a lower rate of dyspnea (26% vs. 50%; difference, 23.6 percentage points [CI, 19.0 to 28.2 percentage points]), and had a higher rate of discharge home from the ED (59% vs. 37%; difference, 21.9 percentage points [-26.5 to -17.1 percentage points]). Compared with Delta, Omicron infection was independently associated with a lower risk for ICU admission (adjusted difference, 11.4 percentage points [CI, 8.4 to 14.4 percentage points]), mechanical ventilation (adjusted difference, 3.6 percentage points [CI, 1.7 to 5.6 percentage points]), and in-hospital mortality (adjusted difference, 4.2 percentage points [CI, 2.0 to 6.5 percentage points]). LIMITATION: Patients with COVID-19 illness and no SARS-CoV-2 variant determination in the ED were excluded. CONCLUSION: Compared with the Delta variant, infection with the Omicron variant in patients in the ED had different clinical and biological patterns and was associated with better in-hospital outcomes, including higher survival. PRIMARY FUNDING SOURCE: None.

Interdisciplinary teamwork for chest tube insertion and management: an integrative review.

Thoracostomy requires interdisciplinary teamwork. Even though thoracic drainage is a technical surgical procedure, nurses play an important role with major responsibilities during the procedure. This literature review aimed to identify articles related to the interdisciplinary management of thoracostomy. An integrative literature analysis between 2012 and 2019 with a qualitative approach was conducted. An analysis of articles written in English, French, Portuguese, and Spanish was conducted. A search of the PubMed and SCIELO databases was performed using combinations of the terms "Chest Tube; Nursing; Care; Drainage; Insertion". The search terms were included in 11,277 articles. After excluding articles that did not meet the objective of our study, 475 abstracts were analysed. Finally, 19 articles were selected with content focused on nursing care, content related to surgical procedures, and interdisciplinary content. Themes included the following: description of the procedure, interdisciplinary action, quality of the procedure, use of protocols for patient safety, and new technologies. In conclusion, interdisciplinary courses should be encouraged to improve interprofessional teamwork organization. Notwithstanding all these publications, the literature was fragmented into disciplines and isolated analyses. Each medical or nursing discipline addressed the aspects that pertain to its own responsibilities in the execution of the procedure. This review highlighted the need to develop interdisciplinary research and brought a source of rich information that can instrumentalize the creation of optimized processes for the interdisciplinary chest tube insertion.

Usability and reproducibility of three tools to assess medical students and residents in emergency medicine.

OBJECTIVES: It is critical to assess competency of medical students and residents in emergency medicine (EM) during undergraduate and graduate medical education. However, very few valid tools exist to assess both technical and nontechnical skills in the specific context of EM. Three Acute Care Assessment Tools (ACAT 1, 2, and 3) have been previously developed for three acute care conditions: cardiac arrest (1), coma (2), and acute respiratory failure (3). This study aimed to evaluate the reproducibility of the tools. METHODS: The tool was tested using recorded videos of simulation sessions of fourth year medical students and first year residents in EM. Raters independently reviewed the videos two times in a 3-month interval, and interrater and intrarater reliability using intraclass correlation (ICC) was calculated. Secondary endpoints included the completeness rate and relevance of the ACAT. RESULTS: Sixty-two sessions were recorded and 48 videos analyzed (18 for CA and 15 for both respiratory failure and coma. The learners were residents in 32 (66%) of videos. Interrater reliability was excellent (ICC >0.9 for all three contexts) and so was the intrarater reliability (>0.88), both upon first review (month 0, M0) and at 3 months (M3). The usability of the ACAT was good, with a completeness of the items that ranged from 96% to 100%. Only one item of the ACAT 1 had a relevance of 27%, as it could not be completed in 13 scenarios out of 18. CONCLUSIONS: The results demonstrate educators can evaluate students similarly utilizing video recordings of simulated medical scenario. The excellent completeness of the rated items advocated for good usability. The three ACATs can be utilized to assess for completeness of predefined tasks in three acute care broad scenario in a competency-based medical education framework.

Medical students' perception of simulation-based assessment in emergency and paediatric medicine: a focus group study.

BACKGROUND: Although simulation-based assessment (SBA) is being implemented in numerous medical education systems, it is still rarely used for undergraduate medical students in France. Objective structured clinical examinations (OSCEs) will be integrated into the national medical curriculum in 2021. In 2016 and 2017, we created a mannequin SBA to validate medical students' technical and psychometric skills during their emergency medicine and paediatric placements. The aim of our study was to determine medical students' perceptions of SBA. METHODS: We followed the grounded theory framework to conduct a qualitative study. A total of 215 students participated in either a paediatric or an emergency medicine simulation-based course with a final assessment. Among the 215 participants, we randomly selected forty students to constitute the focus groups. In the end, 30 students were interviewed. Data were coded and analysed by two independent investigators within the activity theory framework. RESULTS: The analyses found four consensual themes. First, the students perceived that success in the SBA provided them with self-confidence and willingness to participate in their hospital placements (1). They considered SBA to have high face validity (2), and they reported changes in their practice after its implementation (3). Nevertheless, they found that SBA did not help with their final high-stakes assessments (4). They discussed three other themes without reaching consensus: stress, equity, and the structure of SBA. After an analysis with activity theory, we found that students' perceptions of SBA underlined the contradictions between two systems of training: hospital and medical. We hypothesise that a specific role and place for SBA should be defined between these two activity systems. CONCLUSION: The students perceived that SBA would increase self-confidence in their hospital placements and emphasise the general skills required in their future professional environment. However, they also reported that the assessment method might be biased and stressful. Our results concerning a preimplementation mannequin SBA and OSCE could provide valuable insight for new programme design and aid in improving existing programmes. Indeed, SBA seems to have a role and place between hospital placements and medical schools.

Evaluation of the feasibility and impacts of in situ simulation in emergency medicine-a mixed-method study protocol.

INTRODUCTION: In situ simulation (ISS) consists of performing a simulation in the everyday working environment with the usual team members. The feasibility of ISS in emergency medicine is an important research question, because ISS offers the possibility for repetitive, regular simulation training consistent with specific local needs. However, ISS also raises the issue of safety, since it might negatively impact the care of other patients in the emergency department (ED). Our hypothesis is that ISS in an academic high-volume ED is feasible, safe and associated with benefits for both staff and patients. METHODS: A mixed-method, including a qualitative method for the assessment of feasibility and acceptability and a quantitative method for the assessment of patients' safety and participants' psychosocial risks, will be used in this study.Two distinct phases are planned in the ED of the CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus) between March 2021 and October 2021. Phase 1: an ISS programme will be implemented with selected ED professionals to assess its acceptability and safety and prove the validity of our educational concept. The number of cancelled sessions and the reasons for cancellation will be collected to establish feasibility criteria. Semistructured interviews will evaluate the acceptability of the intervention. We will compare unannounced and announced ISS. Phase 2: the impact of the ISS programme will be measured with validated questionnaires for the assessment of psychosocial risks, self-confidence and perceived stress among nonselected ED professionals, with comparison between those exposed to ISS and those that were not. ETHICS AND DISSEMINATION: The CHU de Québec-Université Laval Research ethics board has approved this protocol (#2020-5000). Results will be presented to key professionals from our institution to improve patient safety. We also aim to publish our results in peer-reviewed journals and will submit abstracts to international conferences to disseminate our findings.

Midwifery students' retention of learning after screen-based simulation training on neonatal resuscitation: a pilot study.

Simulation in medical education is widely used to teach both technical and non-technical skills. The use of tools such as screen-based simulation raises the question of their efficiency and the retention rate for knowledge and skills. In this study, we measured midwives' retention of learning after screen-based simulation training on neonatal resuscitation. 14 midwifery students participated in this pilot study. They undertook two screen-based simulation sessions 2 months apart. Measurements included a knowledge quiz, a self-efficacy assessment and two experts' evaluations of the Anaesthetists' Non-Technical Skills (ANTS) and Neonatal Resuscitation Performance Evaluation (NRPE) scoring (non-technical and technical skills, respectively). A demographic survey with open-ended questions on professional experience and learning concluded the study. We showed an improvement in the self-efficacy assessment (p<0.05), the knowledge quiz (p<0.01) and the ANTS evaluation (p<0.0001). However, there was no significant difference in the NRPE score. The students enjoyed the apprenticeship aspect of the screen-based simulation. Repeated exposure to a screen-based simulation on neonatal resuscitation could be advantageous for non-technical skills training, self-confidence and retention of knowledge. This is still a work in progress, undergoing further investigation with more participants and new variables.

Alcohol consumption among French physicians: A cross-sectional study.

BACKGROUND: Data regarding French physicians' alcohol behaviours are scarce and most studies address this issue within the population of either medical students or residents. We aim to describe and assess the prevalence of hazardous alcohol consumption among French physicians. METHODS: A regional, cross-sectional, survey was conducted in 2018 using an online questionnaire among Parisian general practitioners and hospital doctors. Hazardous alcohol consumption was defined by an Alcohol Use Disorders Identification Test (AUDIT) score ≥ 8. Data were analysed in 2020. RESULTS: Five hundred fifteen physicians completed the survey: 108 general practitioners and 407 hospital physicians. The median age was 40 years [32-55] and 59 % were women. They considered their physical and mental health as average or bad in 10 % and 8% of cases, respectively. The prevalence of hazardous alcohol consumption was 12.6 %. Among the 65 physicians with hazardous alcohol consumption, 27 (41.5 %) did not considered it as risky and four (6.2 %) mentioned a potentially negative impact on patients' care. Factors independently associated with hazardous alcohol consumption were illegal drugs consumption (OR 4.62 [2.05-10.37]) and fixed term contract for hospital doctors (OR 2.69 [1.14-6.36]). CONCLUSIONS: The prevalence of hazardous alcohol consumption among French physicians was 12.6 %. Illegal substance users and fix-termed contract hospital doctors were more likely to have risky alcohol consumption. A large-scale national study would confirm the factors associated with hazardous alcohol consumption and could explore the efficacy of preventive measures to insure the safety and health of physicians and their patients.

Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure: The ELISABETH Randomized Clinical Trial.

Importance: Clinical guidelines for the early management of acute heart failure in the emergency department (ED) setting are based on only moderate levels of evidence, with subsequent low adherence to these guidelines. Objective: To test the effect of an early guideline-recommended care bundle on short-term prognosis in older patients with acute heart failure in the ED. Design, Setting, and Participants: Stepped-wedge cluster randomized trial in 15 EDs in France of 503 patients 75 years and older with a diagnosis of acute heart failure in the ED from December 2018 to September 2019 and followed up for 30 days until October 2019. Interventions: A care bundle that included early intravenous nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of intravenous diuretics (n = 200). In the control group, patient care was left to the discretion of the treating emergency physician (n = 303). Each center was randomized to the order in which they switched to the "intervention period." After the initial 4-week control period for all centers, 1 center entered in the intervention period every 2 weeks. Main Outcomes and Measures: The primary end point was the number of days alive and out of hospital at 30 days. Secondary outcomes included 30-day all-cause mortality, 30-day cardiovascular mortality, unscheduled readmission, length of hospital stay, and kidney impairment. Results: Among 503 patients who were randomized (median age, 87 years; 298 [59%] women), 502 were analyzed. In the intervention group, patients received a median (interquartile range) of 27.0 (9-54) mg of intravenous nitrates in the first 4 hours vs 4.0 (2.0-6.0) mg in the control group (adjusted difference, 23.8 [95% CI, 13.5-34.1]). There was a significantly higher percentage of patients in the intervention group treated for their precipitating factors than in the control group (58.8% vs 31.9%; adjusted difference, 31.1% [95% CI, 14.3%-47.9%]). There was no statistically significant difference in the primary end point of the number of days alive and out of hospital at 30 days (median [interquartile range], 19 [0- 24] d in both groups; adjusted difference, -1.9 [95% CI, -6.6 to 2.8]; adjusted ratio, 0.88 [95% CI, 0.64-1.21]). At 30 days, there was no significant difference between the intervention and control groups in mortality (8.0% vs 9.7%; adjusted difference, 4.1% [95% CI, -17.2% to 25.3%]), cardiovascular mortality (5.0% vs 7.4%; adjusted difference, 2.1% [95% CI, -15.5% to 19.8%]), unscheduled readmission (14.3% vs 15.7%; adjusted difference, -1.3% [95% CI, -26.3% to 23.7%]), median length of hospital stay (8 d in both groups; adjusted difference, 2.5 [95% CI, -0.9 to 5.8]), and kidney impairment (1% in both groups). Conclusions and Relevance: Among older patients with acute heart failure, use of a guideline-based comprehensive care bundle in the ED compared with usual care did not result in a statistically significant difference in the number of days alive and out of the hospital at 30 days. Further research is needed to identify effective treatments for acute heart failure in older patients. Trial Registration: ClinicalTrials.gov Identifier: NCT03683212.

The impact of psychological factors on the management of intraoperative haemodynamic events in children.

INTRODUCTION: Paediatric anaesthesia requires specific theoretical knowledge and practical training. Non-technical skills and psychological factors might influence learning and practice. The aim of this study was to assess personality type and decision-making styles of paediatric anaesthesiology residents during the management of simulated intraoperative life-threatening cases. METHOD: Residents in anaesthesiology (between 4 and 5 years of training) participated in a simulated hypoxic cardiac arrest in the operating theatre. Their performance was evaluated using a score derived from international recommended management algorithm. They were asked to answer self-assessment questionnaires regarding both their personality (the five personality factors) and their decision-making style. Correlations between performance and personality were investigated. RESULTS: Thirty-eight residents participated in the simulation session and 36 accepted to answer the questionnaires. Good management scoring was positively correlated with agreeableness and conscientiousness personality traits but was negatively correlated with avoidance and spontaneous decision-making styles. DISCUSSION: The current study identified personality traits and decision-making styles that might influence the management of critical situations during paediatric anaesthesia. The proper identification of these factors might allow targeted personalised training to improve knowledge mobilisation and translation in the clinical context.

Impact of panelists' experience on script concordance test scores of medical students.

BACKGROUND: The evaluation process of French medical students will evolve in the next few years in order to improve assessment validity. Script concordance testing (SCT) offers the possibility to assess medical knowledge alongside clinical reasoning under conditions of uncertainty. In this study, we aimed at comparing the SCT scores of a large cohort of undergraduate medical students, according to the experience level of the reference panel. METHODS: In 2019, the authors developed a 30-item SCT and sent it to experts with varying levels of experience. Data analysis included score comparisons with paired Wilcoxon rank sum tests and concordance analysis with Bland & Altman plots. RESULTS: A panel of 75 experts was divided into three groups: 31 residents, 21 non-experienced physicians (NEP) and 23 experienced physicians (EP). Among each group, random samples of N = 20, 15 and 10 were selected. A total of 985 students from nine different medical schools participated in the SCT examination. No matter the size of the panel (N = 20, 15 or 10), students' SCT scores were lower with the NEP group when compared to the resident panel (median score 67.1 vs 69.1, p < 0.0001 if N = 20; 67.2 vs 70.1, p < 0.0001 if N = 15 and 67.7 vs 68.4, p < 0.0001 if N = 10) and with EP compared to NEP (65.4 vs 67.1, p < 0.0001 if N = 20; 66.0 vs 67.2, p < 0.0001 if N = 15 and 62.5 vs 67.7, p < 0.0001 if N = 10). Bland & Altman plots showed good concordances between students' SCT scores, whatever the experience level of the expert panel. CONCLUSIONS: Even though student SCT scores differed statistically according to the expert panels, these differences were rather weak. These results open the possibility of including less-experienced experts in panels for the evaluation of medical students.

Effect of Computer Debriefing on Acquisition and Retention of Learning After Screen-Based Simulation of Neonatal Resuscitation: Randomized Controlled Trial.

BACKGROUND: Debriefing is key in a simulation learning process. OBJECTIVE: This study focuses on the impact of computer debriefing on learning acquisition and retention after a screen-based simulation training on neonatal resuscitation designed for midwifery students. METHODS: Midwifery students participated in 2 screen-based simulation sessions, separated by 2 months, session 1 and session 2. They were randomized in 2 groups. Participants of the debriefing group underwent a computer debriefing focusing on technical skills and nontechnical skills at the end of each scenario, while the control group received no debriefing. In session 1, students participated in 2 scenarios of screen-based simulation on neonatal resuscitation. During session 2, the students participated in a third scenario. The 3 scenarios had an increasing level of difficulty, with the first representing the baseline level. Assessments included a knowledge questionnaire on neonatal resuscitation, a self-efficacy rating, and expert evaluation of technical skills as per the Neonatal Resuscitation Performance Evaluation (NRPE) score and of nontechnical skills as per the Anaesthetists' Non-Technical Skills (ANTS) system. We compared the results of the groups using the Mann-Whitney U test. RESULTS: A total of 28 midwifery students participated in the study. The participants from the debriefing group reached higher ANTS scores than those from the control group during session 1 (13.25 vs 9; U=47.5; P=.02). Their scores remained higher, without statistical difference during session 2 (10 vs 7.75; P=.08). The debriefing group had higher self-efficacy ratings at session 2 (3 vs 2; U=52; P=.02). When comparing the knowledge questionnaires, the significant baseline difference (13 for debriefing group vs 14.5 for control group, P=.05) disappeared at the end of session 1 and in session 2. No difference was found for the assessment of technical skills between the groups or between sessions. CONCLUSIONS: Computer debriefing seems to improve nontechnical skills, self-efficacy, and knowledge when compared to the absence of debriefing during a screen-based simulation. This study confirms the importance of debriefing after screen-based simulation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03844009; https://clinicaltrials.gov/ct2/show/NCT03844009.

Association Between Pulmonary Embolism and COVID-19 in Emergency Department Patients Undergoing Computed Tomography Pulmonary Angiogram: The PEPCOV International Retrospective Study.

BACKGROUND: There have been reports of procoagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients who underwent a computed tomographic pulmonary angiogram (CTPA). METHODS: A retrospective study in 26 EDs from six countries. ED patients in whom a CTPA was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a PE on CTPA. COVID-19 was diagnosed in the ED either on CT or reverse transcriptase-polymerase chain reaction. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period. RESULTS: A total of 3,358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3,253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean (±SD) age was 61 (±19) years and 52% were women. A PE was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio = 0.98, 95% confidence interval = 0.76 to 1.26). There was no association when limited to patients in the pandemic period. CONCLUSION: In ED patients who underwent CTPA for suspected PE, COVID-19 was not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.