The goal of this study was to learn whether the MCIPHER memory aid could help first-year resident doctors manage a simulated mass-casualty incident. MCIPHER organizes the response into five phases: command, triage, treatment, transport, and closure. Twenty-five postgraduate year-1 residents from emergency medicine, trauma surgery, general surgery, and anaesthesiology took part. All participants completed the same two-week course on mass-casualty incident response. Researchers then placed participants into one of two groups using a non-random method. The control group completed a three-dimensional tabletop simulation after the standard course. The MCIPHER group received an additional structured briefing on MCIPHER immediately before completing the same simulation. The main questions were: Did MCIPHER affect overall team performance? Did MCIPHER affect how quickly teams completed key actions? Did MCIPHER affect how accurately teams triaged simulated casualties? Researchers also measured participants' confidence, knowledge, attitudes, views of the debrief, and views of MCIPHER. Each team managed the same simulated incident involving 25 casualties. The exercise lasted about 60 minutes and was followed by a structured debrief lasting about 20 minutes.
This completed proof-of-concept study used a quasi-experimental, non-randomized, two-group design. All participants completed a standardized two-week didactic curriculum on mass-casualty incident response. Group A completed the first tabletop exercise without exposure to MCIPHER. Group B received an additional structured MCIPHER pre-brief immediately before the first exercise. Each group formed one team and independently managed the same three-dimensional tabletop scenario involving 25 simulated casualties. A game master controlled scenario progression and provided neutral prompts only when a team stalled for at least 30 seconds after a cue. The active exercise lasted approximately 60 minutes and was followed by an approximately 20-minute structured debrief. Only each team's first exercise was used for the between-group comparison to avoid carryover learning effects. Group A later received access to the MCIPHER educational content, but later performance data were not included in the analysis reported in this record.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
25
All participants completed a standardized two-week didactic curriculum on mass-casualty incident response. The curriculum covered introduction to mass-casualty incident management, response activation and scene setup, triage and decision-making, treatment and resource allocation, evacuation and transport, and response conclusion and recovery.
Participants in the MCIPHER group received structured pre-brief immediately before the tabletop exercise. The pre-brief introduced MCIPHER as a cognitive roadmap for sequencing and prioritizing mass-casualty incident response. The framework consists of five sequential phases: C.O.M.M.A.N.D. for command and scene management, S.O.R.T. for triage, C.A.R.E. for treatment, M.O.V.E. for transport, and C.L.E.A.R. for closure and debrief.
Participants completed a standardized three-dimensional tabletop simulation involving 25 simulated casualties. The active exercise lasted approximately 60 minutes and was followed by an approximately 20-minute structured debrief.
Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU)
Dubai, United Arab Emirates
Percentage Team Performance Score During the First Tabletop Exercise
Each team's performance was assessed across 20 predefined critical actions spanning command, triage, treatment, transport, and closure. Each action was scored as 1.0 for full completion in the correct sequence and within the timing window without prompting, 0.5 for partial, delayed, incomplete, or prompted completion, and 0.0 for an action that was not observed, incorrect, or out of sequence. Scores were summed, divided by 20, and multiplied by 100. Scores range from 0 to 100 percentage points; higher scores indicate better team performance.
Time frame: During the first tabletop exercise, approximately 60 minutes
Percentage Operational Timeliness Index During the First Tabletop Exercise
The number of 20 predefined critical actions completed within their benchmark timing windows, allowing a plus or minus 2-minute tolerance, was divided by 20 and multiplied by 100. Scores range from 0 to 100 percentage points; higher scores indicate that a larger proportion of critical actions were completed on time.
Time frame: During the first tabletop exercise, approximately 60 minutes
Percentage Initial Triage Accuracy Score During the First Tabletop Exercise
The number of 25 simulated casualties assigned the correct initial triage category compared with the predefined gold-standard category was divided by 25 and multiplied by 100. Scores range from 0 to 100 percentage points; higher scores indicate greater initial triage accuracy.
Time frame: At completion of initial triage during the first tabletop exercise, within approximately 60 minutes
Mean Change From Pre-training to Post-training in Composite Self-Reported Confidence Score
Self-reported confidence was assessed using nine items scored from 1 to 5 and covering mass-casualty incident command, triage, treatment, transport, and communication. The composite score was the mean of the nine items and ranges from 1 to 5; higher scores indicate greater confidence. Change was calculated as the post-training score minus the pre-training score.
Time frame: Immediately before the tabletop simulation (Baseline) and immediately after the 20-minute post-simulation debrief, approximately 80 minutes after simulation start (Day 1)
Change From Pre-training to Post-training in Mass-Casualty Incident Attitude Item Scores
Attitudes were assessed using four individual items scored from 1 to 5. The items assessed perceived preparedness and attitudes toward mass-casualty incident training. Each item was analyzed separately. Higher scores indicate stronger agreement with the item. Change for each item was calculated as the post-training score minus the pre-training score.
Time frame: Immediately before the tabletop simulation (Baseline) and immediately after the 20-minute post-simulation debrief, approximately 80 minutes after simulation start (Day 1)
Mean Post-training Debrief Experience Score
Debrief experience was assessed using seven items scored from 1 to 5. The items assessed the perceived quality, realism, and usefulness of the tabletop exercise and structured debrief. The composite score was the mean of the seven items and ranges from 1 to 5; higher scores indicate a more favorable debrief experience.
Time frame: Immediately after the 20-minute post-simulation debrief, approximately 80 minutes after simulation start (Day 1)
Mean Post-training MCIPHER Perception Score
Participants in the MCIPHER group completed four items scored from 1 to 5 that assessed the perceived usefulness, clarity, and applicability of the MCIPHER framework. The composite score was the mean of the four items and ranges from 1 to 5; higher scores indicate a more favorable perception of MCIPHER.
Time frame: Immediately after the 20-minute post-simulation debrief, approximately 80 minutes after simulation start (Day 1)
Percentage Correct on the Post-training Knowledge Test
Knowledge was assessed using a 30-item binary test covering mass-casualty incident management concepts aligned with the didactic curriculum. The number of correct responses was divided by 30 and multiplied by 100. Scores range from 0 to 100 percentage points; higher scores indicate greater post-training knowledge. Different test versions were administered to the two groups, so results were summarized within each group rather than directly compared between groups.
Time frame: Immediately after the 20-minute post-simulation debrief, approximately 80 minutes after simulation start (Day 1)
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