Newly Published
Education  |   January 2018
Relaxation before Debriefing during High-fidelity Simulation Improves Memory Retention of Residents at Three Months: A Prospective Randomized Controlled Study
Author Notes
  • From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital de la Croix Rousse, Département d’anesthésie-réanimation, Lyon, France (C.B., C.P.); Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d’anesthésie-réanimation, Lyon, France (J.-C.C., A.F., C.P., B.B.X., T.R.); Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Département d’anesthésie-réanimation, Bron, France (B.B., C.P., J.-J.L.); Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, Lyon, France (B.B., C.P.); Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Département d’anesthésie-réanimation, Pierre-Bénite, France (O.V., C.P.); Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France (C.P., A.D.); and EA 7426 Hospices Civils de Lyon – bioMérieux – Université Claude Bernard Lyon 1 “Pathophysiology of Injury Induced Immunosuppression,” Lyon, France (T.R.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • This study was presented in part at the annual meeting of the French Society of Anesthesiology and Critical Care Medicine (Sfar) on September 18, 2015, and September 23, 2016, respectively.
    This study was presented in part at the annual meeting of the French Society of Anesthesiology and Critical Care Medicine (Sfar) on September 18, 2015, and September 23, 2016, respectively.×
  • Submitted for publication April 12, 2017. Accepted for publication November 20, 2017.
    Submitted for publication April 12, 2017. Accepted for publication November 20, 2017.×
  • Acknowledgments: The authors thank Sebastien Grousson, M.D., Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Département d’anesthésie-réanimation, Bron, France, for his implication in the simulation sessions and the study protocol during all the study inclusion period; Pierre-Yves Carry, M.D., Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Département d’anesthésie-réanimation, Pierre-Bénite, France, for his implication in the simulation sessions and the study protocol during all the study inclusion period; Nathalie Richard, M.D., Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département de réanimation, Bron, France, for her implication in the simulation sessions and the study protocol during all the study inclusion period; all students, simulation instructors, and simulation technicians of the Université Claude-Bernard Lyon1 Simulation Center, Lyon, France; Philip Robinson, Ph.D., Direction de la Recherche Clinique et de l’Innovation, Hospices Civils de Lyon, Lyon, France, for revision of the manuscript and the translation guidance; Darren Raphael, M.D., Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, for the substantial English revision of the manuscript; Christopher Blakeley, M.D., Ph.D., Emergency Department, Westnine Medical Ltd., London, United Kingdom, for the substantial English revision of the manuscript; and Yvette Lilot for the translation guidance of the relaxation text.
    Acknowledgments: The authors thank Sebastien Grousson, M.D., Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Département d’anesthésie-réanimation, Bron, France, for his implication in the simulation sessions and the study protocol during all the study inclusion period; Pierre-Yves Carry, M.D., Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Département d’anesthésie-réanimation, Pierre-Bénite, France, for his implication in the simulation sessions and the study protocol during all the study inclusion period; Nathalie Richard, M.D., Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département de réanimation, Bron, France, for her implication in the simulation sessions and the study protocol during all the study inclusion period; all students, simulation instructors, and simulation technicians of the Université Claude-Bernard Lyon1 Simulation Center, Lyon, France; Philip Robinson, Ph.D., Direction de la Recherche Clinique et de l’Innovation, Hospices Civils de Lyon, Lyon, France, for revision of the manuscript and the translation guidance; Darren Raphael, M.D., Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, for the substantial English revision of the manuscript; Christopher Blakeley, M.D., Ph.D., Emergency Department, Westnine Medical Ltd., London, United Kingdom, for the substantial English revision of the manuscript; and Yvette Lilot for the translation guidance of the relaxation text.×
  • Research Support: Support was provided solely from institutional and/or ­departmental sources.
    Research Support: Support was provided solely from institutional and/or ­departmental sources.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: marclilot@hotmail.com. Raw data available at: marclilot@hotmail.com.
    Reproducible Science: Full protocol available at: marclilot@hotmail.com. Raw data available at: marclilot@hotmail.com.×
  • Correspondence: Address correspondence to Dr. Lilot: Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, 59 Boulevard Pinel, 69500 Bron, France. marclilot@hotmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Education / CPD
Education   |   January 2018
Relaxation before Debriefing during High-fidelity Simulation Improves Memory Retention of Residents at Three Months: A Prospective Randomized Controlled Study
Anesthesiology Newly Published on January 11, 2018. doi:10.1097/ALN.0000000000002045
Anesthesiology Newly Published on January 11, 2018. doi:10.1097/ALN.0000000000002045
Abstract

Background: High-fidelity simulation is known to improve participant learning and behavioral performance. Simulation scenarios generate stress that affects memory retention and may impact future performance. The authors hypothesized that more participants would recall three or more critical key messages at three months when a relaxation break was performed before debriefing of critical event scenarios.

Methods: Each resident actively participated in one scenario and observed another. Residents were randomized in two parallel-arms. The intervention was a 5-min standardized relaxation break immediately before debriefing; controls had no break before debriefing. Five scenario-specific messages were read aloud by instructors during debriefings. Residents were asked by telephone three months later to recall the five messages from their two scenarios, and were scored for each scenario by blinded investigators. The primary endpoint was the number of residents participating actively who recalled three or more messages. Secondary endpoints included: number of residents observing who recalled three or more messages, anxiety level, and debriefing quality.

Results: In total, 149 residents were randomized and included. There were 52 of 73 (71%) residents participating actively who recalled three or more messages at three months in the intervention group versus 35 of 76 (46%) among controls (difference: 25% [95% CI, 10 to 40%], P = 0.004). No significant difference was found between groups for observers, anxiety or debriefing quality.

Conclusions: There was an additional 25% of active participants who recalled the critical messages at three months when a relaxation break was performed before debriefing of scenarios. Benefits of relaxation to enhance learning should be considered for medical education.