E-learning Proficiency Based Progression Training Programme for Clinical Communication on ISBAR Performance (eISBAR)

Overview

Objective: To determine the effectiveness of proficiency based inter-professional communication training in an online environment on medical student's use of the ISBAR (Identify, Situation, Background, Assessment, Recommendation) communication escalation protocol in the deteriorating patient Setting: The study will be conducted in University College Cork, Ireland. Participants: 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 for training before undertaking a performance assessment of an ISBAR communication relevant to a deteriorating patient in a low fidelity simulation environment: HSE group (the national e-learning programme only); S group (national e- learning plus access to online scenarios and facilitator when requested) and PBP group (national e-learning plus access to online scenarios training course with in-built proficiency-based progression, and facilitator when requested). 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. It has also not yet been validated through the medium of virtual learning. 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 an e-learning training course 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 e-learning course with scenarios or proficiency-based progression (PBP) e-learning course with scenarios. Participants will be prospectively randomized to one of three training groups. Following a pre-test observation through low-fidelity simulation, they will then undergo their respective training courses before undertaking a post-test performance assessment of an ISBAR communication relevant to a deteriorating patient in a low fidelity simulation environment: 1. Online learning only (HSE) -the national e-learning programme only 2. Scenarios (S) -national online learning plus online scenario course training 3. Proficiency based progression (PBP) -national online learning plus proficiency-based progression online scenario course training. 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 supply 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 experts for a series of paper-based simulation cases and a standardised high fidelity simulation case used as the assessment case. This case will be used in this study in a low fidelity environment. The proficiency benchmark for each case has been set based on the performance of experienced medical personnel on each case as a series of steps, errors and critical errors. Outcome assessment will be scored by reviewing auditory recordings of ISBAR performance by each participant on the standardised case in the low fidelity simulated environment.