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Just‐in‐time clinical video review improves successful placement of Sengstaken‐Blakemore tube by emergency medicine resident physicians: A randomized control simulation‐based study
Author(s) -
Bonz James W.,
Pope Joshua K.,
Wong Ambrose H.,
Ray Jessica M.,
Evans Leigh V.
Publication year - 2021
Publication title -
aem education and training
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 9
ISSN - 2472-5390
DOI - 10.1002/aet2.10573
Subject(s) - checklist , randomized controlled trial , medicine , intervention (counseling) , physical therapy , psychology , surgery , nursing , cognitive psychology
Objective Successful completion of life‐saving procedures may benefit from a concise just‐in‐time (JIT) intervention. Video is an optimal medium for JIT training, but currently available video‐based references are not optimized for a JIT format, especially in time‐pressured situations prior to high‐risk clinical contexts. We aimed to create and evaluate the efficacy of a brief video review of emergent Sengstaken‐Blakemore tube (SBT) insertion for acutely decompensating variceal hemorrhage when used just prior to clinical performance in a simulated setting. Methods We created a less than 3‐minute audio‐optional JIT training video on SBT insertion. We recruited emergency medicine resident physicians to participate in a simulation scenario in which they had to quickly place an SBT. Participants were randomized to either a 3‐minute procedure review by any media they chose (control) or review of the JIT video (intervention). Performance on a checklist created by a multidisciplinary group of SBT experts (passing score > 18 and maximum = 28) served as the primary outcome. We analyzed performance in checklist scores controlling level of training through a one‐way analysis of covariance (ANCOVA). We analyzed rates of passing scores via a chi‐square analysis. Results We randomized 32 participants to media review (control) or JIT video (intervention). The intervention group had an overall mean (±SD) performance of 19.8 (±9.0) and the control group had a mean (±SD) score of 6.6 (±7.4). After adjusting for postgraduate year, we found a significant difference in final checklist scores between the two groups (mean difference = 12.8, 95% confidence interval [CI] = 7.6 to 18.0). Percentages of participants reaching a minimum passing score were two of 16 (12.5%) in the control group and 10 of 16 (62.5%) in the intervention group (odds ratio = 11.7, 95% CI = 9.9 to 13.5). Cohen's kappa indicated substantial agreement (κ = 0.714) between reviewer scores. Conclusions A readily available, focused, audio‐optional JIT video increased performance for SBT insertion in a simulated setting. Future work may include testing of this format for more commonly performed emergency procedures and determination of effect on bedside performance in the clinical setting.