AgeingNCT02683447
Ageing and Acute Care Physicians' Performance
An observational study of Ageing, run by Sunnybrook Health Sciences Centre at 2 sites in Canada.
Trial summary
The proportion of older acute care physicians (ACPs) has been increasing. Ageing is associated with physiological changes and research investigating how such age-related physiological changes affect clinical performance is lacking. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Ageing
- What is being tested?
- CRM Simulation
- How many people
- 48 participants
- Where
- 2 sitesCanada
- Study dates
- Jan 2017to Jan 2020
- Phase
- Observational
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Study population: Practicing emergency, critical care and anesthesia staff with a minimum 5 years of practice post residency will be approached for participation.
Who may be able to join
- Emergency physicians
- Critical care physicians
- Anesthesiologists
- minimum 5 years of practice post-residency
Who cannot join
- Post-call day of participation
Trial locations and contacts
2 sites in 1 country.
Canada2 sites
University of Ottawa
Ottawa, Ontario, K1H 8L6
Sunnybrook Health Sciences Centre
Toronto, Ontario, M4N3M5
About this study
Official title: Impact of Acute Care Physician's Age on Crisis Management Performance and Learning After Simulation-based Education
The proportion of older acute care physicians (ACPs) has been increasing. Ageing is associated with physiological changes and research investigating how such age-related physiological changes affect clinical performance is lacking. Specifically, Crisis Resource Management (CRM) consists of essential clinical skills in acute care specialties which when absent, can significantly impact patient safety. As such, the goals of this study are to investigate whether ageing has a correlation with baseline CRM skills of ACPs and whether ageing influences learning from high fidelity simulation.
Read the detailed description
The proportion of older acute care physicians (ACP), emergency, critical care \& anesthesia, has been steadily increasing. Ageing is associated with physiological changes, which in turn can influence a physician's clinical abilities and decision-making. The litigation and physician disciplinary data suggests that incidents involving all physicians are likely to occur later in practice, with degree of injury identified in the claims being of greater severity. However research, investigating how age-related physiological changes affect clinical performance and patient safety, is lacking.
CRM skills are essential skills within acute care specialties, and are vital for patient safety. CRM encompasses technical skills, as well as a rapid and organized approach to non-technical, cognitive skills such as decision-making, task management, situational awareness and team management. High-fidelity full body mannequin simulation-based education is effective for learning CRM, including transfer of skills from the simulated setting to the clinical setting and improving patient outcome. However, there is a gap in the literature on whether physicians' age influences baseline CRM performance and also learning from simulation-based education.
Although the effectiveness of high-fidelity simulation-based education has been studied extensively in junior learner populations (students, residents, fellows), there are a limited number of studies investigating its effectiveness in teaching CRM in the ageing physician population. In fact, a recent systematic review looking at the role of simulation in continuing medical education (CME) in ACPs supported that there is limited evidence supporting improved learning. Despite not knowing whether simulation is the correct tool in an ageing population, it is being recommended as a training, regulation and assessment tool for practicing physicians.
Objectives:
The goals of this study are to:
- Investigate whether ageing has a correlation with baseline CRM skills of ACPs using simulated crisis scenarios and
- Assess whether ageing influences learning from high fidelity simulation.
- Conditions
- Ageing
- Being tested
- CRM Simulation
- Keywords
- Continuing Medical Education, Simulation, Non-technical Skills, Crisis Resource Management
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CRM SimulationOther
Each participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test.
| Study group | Role | What they receive |
|---|---|---|
| CRM Simulation | Each participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test. Receives: Other: CRM Simulation |
What is being measured
The primary outcome is the main question the study is designed to answer.
CRM Performance During First Sim Scenario Assessed by Ottawa Global Rating Scale (GRS)
Ottawa GRS score correlated with chronological age. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance.
Measured: After managing first simulation scenario - Day 1
CRM Performance During First Sim Scenario Assessed by ACLS Checklist
ACLS (Advanced Cardiac Life Support) score will be correlated with chronological age. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance.
Measured: After managing first simulation scenario - Day 1
Secondary outcomes (2)
Learning From High-fidelity Simulation Education Assessed by Ottawa Global Rating Scale
Ottawa GRS score will be compared to score in first scenario to look for improvement. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance. The mean difference in GRS score between pre-test (scenario 1) and immediate post-test (scenario 2) is reported.
Measured: After managing second simulation scenario - Day 1
Learning From High-fidelity Simulation Education Assessed by ACLS Checklist
ACLS (Advanced Cardiac Life Support) score will be compared to score in first scenario to look for improvement. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance. The mean difference in ACLS score between pre-test (scenario 1) and immediate post-test (scenario 2) is reported.
Measured: After managing second simulation scenario - Day 1
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 Feb 2016 (estimated)
- Study startJan 2017
- Primary completionJan 2020
- Study completionJan 2020
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (25)Papers the sponsor has linked to this study.
- Other trials for AgeingStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 48 participants (actual)
Sponsor and investigators
- Lead sponsor
- Sunnybrook Health Sciences Centre
- Sponsor type
- University, hospital or other
- Collaborators
- University of Toronto, University of Ottawa
- Responsible party
- Principal investigator, Dr. Fahad Alam, Sunnybrook Health Sciences Centre
- Investigators
- Fahad Alam, MD, FRCPC, Principal investigator, Sunnybrook Health Sciences CentreSylvain Boet, MD, MEd, PhD, Principal investigator, University of Ottawa
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02683447
- Sponsor's protocol ID
- 140-2015
- Status last verified
- Dec 2024
- First submitted
- 9 Feb 2016
- Last updated
- 20 Jan 2025
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Katz JD. Issues of concern for the aging anesthesiologist. Anesth Analg. 2001 Jun;92(6):1487-92. doi: 10.1097/00000539-200106000-00027. No abstract available.
PubMed 11375831Baxter AD, Boet S, Reid D, Skidmore G. The aging anesthesiologist: a narrative review and suggested strategies. Can J Anaesth. 2014 Sep;61(9):865-75. doi: 10.1007/s12630-014-0194-x. Epub 2014 Jul 2.
PubMed 24985937Baird M, Daugherty L, Kumar KB, Arifkhanova A. Regional and Gender Differences and Trends in the Anesthesiologist Workforce. Anesthesiology. 2015 Nov;123(5):997-1012. doi: 10.1097/ALN.0000000000000834.
PubMed 26291778Siu LW, Boet S, Borges BC, Bruppacher HR, LeBlanc V, Naik VN, Riem N, Chandra DB, Joo HS. High-fidelity simulation demonstrates the influence of anesthesiologists' age and years from residency on emergency cricothyroidotomy skills. Anesth Analg. 2010 Oct;111(4):955-60. doi: 10.1213/ANE.0b013e3181ee7f4f. Epub 2010 Aug 24.
PubMed 20736429Daugherty L, Fonseca R, Kumar KB, Michaud PC. An Analysis of the Labor Markets for Anesthesiology. Rand Health Q. 2011 Sep 1;1(3):18. eCollection 2011 Fall.
PubMed 28083205Duke, E. (2006). The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians : Report to Congress (p. 36). U.S. Department of Health & Human Sciences.
Durning SJ, Artino AR, Holmboe E, Beckman TJ, van der Vleuten C, Schuwirth L. Aging and cognitive performance: challenges and implications for physicians practicing in the 21st century. J Contin Educ Health Prof. 2010 Summer;30(3):153-60. doi: 10.1002/chp.20075.
PubMed 20872769Eva KW. The aging physician: changes in cognitive processing and their impact on medical practice. Acad Med. 2002 Oct;77(10 Suppl):S1-6. doi: 10.1097/00001888-200210001-00002. No abstract available.
PubMed 12377689Trunkey DD, Botney R. Assessing competency: a tale of two professions. J Am Coll Surg. 2001 Mar;192(3):385-95. doi: 10.1016/s1072-7515(01)00770-0. No abstract available.
PubMed 11245381Turnbull J, Carbotte R, Hanna E, Norman G, Cunnington J, Ferguson B, Kaigas T. Cognitive difficulty in physicians. Acad Med. 2000 Feb;75(2):177-81. doi: 10.1097/00001888-200002000-00018.
PubMed 10693852Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Educ. 2007 Dec;41(12):1140-5. doi: 10.1111/j.1365-2923.2007.02914.x. Epub 2007 Nov 13.
PubMed 18004990Tessler MJ, Shrier I, Steele RJ. Association between anesthesiologist age and litigation. Anesthesiology. 2012 Mar;116(3):574-9. doi: 10.1097/ALN.0b013e3182475ebf.
PubMed 22354239Alam A, Khan J, Liu J, Klemensberg J, Griesman J, Bell CM. Characteristics and rates of disciplinary findings amongst anesthesiologists by professional colleges in Canada. Can J Anaesth. 2013 Oct;60(10):1013-9. doi: 10.1007/s12630-013-0006-8. Epub 2013 Jul 30.
PubMed 23897490Duclos A, Peix JL, Colin C, Kraimps JL, Menegaux F, Pattou F, Sebag F, Touzet S, Bourdy S, Voirin N, Lifante JC; CATHY Study Group. Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study. BMJ. 2012 Jan 10;344:d8041. doi: 10.1136/bmj.d8041.
PubMed 22236412Khaliq AA, Dimassi H, Huang CY, Narine L, Smego RA Jr. Disciplinary action against physicians: who is likely to get disciplined? Am J Med. 2005 Jul;118(7):773-7. doi: 10.1016/j.amjmed.2005.01.051.
PubMed 15989912
Study at a glance
From the registry record, last updated by the sponsor on 20 Jan 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Impact of Acute Care Physician's Age on Crisis Management Performance and Learning After Simulation-based Education
- ClinicalTrials.gov ID
- NCT02683447
- Acronym / sponsor ID
- 140-2015
- Conditions
- Ageing
- Keywords
- Continuing Medical Education, Simulation, Non-technical Skills, Crisis Resource Management
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 48 participants (actual)
- Lead sponsor
- Sunnybrook Health Sciences CentreUniversity, hospital or other
- Collaborators
- University of Toronto, University of Ottawa
- Study start
- Jan 2017 (actual)
- Primary completion
- Jan 2020 (actual)
- Study completion
- Jan 2020 (actual)
- First posted
- 17 Feb 2016 (estimated)
- Results
- Posted 20 Jan 2025
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The proportion of older acute care physicians (ACPs) has been increasing. Ageing is associated with physiological changes and research investigating how such age-related physiological changes affect clinical performance is lacking. Specifically, Crisis Resource Management (CRM) consists of essential clinical skills in acute care specialties which when absent, can significantly impact patient safety. As such, the goals of this study are to investigate whether ageing has a correlation with baseline CRM skills of ACPs and whether ageing influences learning from high fidelity simulation.
Detailed description
The proportion of older acute care physicians (ACP), emergency, critical care \& anesthesia, has been steadily increasing. Ageing is associated with physiological changes, which in turn can influence a physician's clinical abilities and decision-making. The litigation and physician disciplinary data suggests that incidents involving all physicians are likely to occur later in practice, with degree of injury identified in the claims being of greater severity. However research, investigating how age-related physiological changes affect clinical performance and patient safety, is lacking.
CRM skills are essential skills within acute care specialties, and are vital for patient safety. CRM encompasses technical skills, as well as a rapid and organized approach to non-technical, cognitive skills such as decision-making, task management, situational awareness and team management. High-fidelity full body mannequin simulation-based education is effective for learning CRM, including transfer of skills from the simulated setting to the clinical setting and improving patient outcome. However, there is a gap in the literature on whether physicians' age influences baseline CRM performance and also learning from simulation-based education.
Although the effectiveness of high-fidelity simulation-based education has been studied extensively in junior learner populations (students, residents, fellows), there are a limited number of studies investigating its effectiveness in teaching CRM in the ageing physician population. In fact, a recent systematic review looking at the role of simulation in continuing medical education (CME) in ACPs supported that there is limited evidence supporting improved learning. Despite not knowing whether simulation is the correct tool in an ageing population, it is being recommended as a training, regulation and assessment tool for practicing physicians.
Objectives:
The goals of this study are to:
- Investigate whether ageing has a correlation with baseline CRM skills of ACPs using simulated crisis scenarios and
- Assess whether ageing influences learning from high fidelity simulation.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| CRM Simulation | – | Other: CRM SimulationEach participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
- Study population
- Practicing emergency, critical care and anesthesia staff with a minimum 5 years of practice post residency will be approached for participation.
Key inclusion criteria (4 listed)
- Emergency physicians
- Critical care physicians
- Anesthesiologists
- minimum 5 years of practice post-residency
Key exclusion criteria (1 listed)
- Post-call day of participation
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| CRM SimulationEach participant will manage a PEA arrest scenario (pre-test) and then be debriefed on their CRM skills by a trained facilitator for 20 minutes. They will then manage another crisis scenario (PEA arrest with a different inciting event) as an immediate post-test. Three months afterwards participants will return to manage a third PEA arrest scenario, which will serve as a retention post-test. | Other | CRM Simulation |
Primary outcome
CRM Performance During First Sim Scenario Assessed by Ottawa Global Rating Scale (GRS)
Time frame: After managing first simulation scenario - Day 1
Ottawa GRS score correlated with chronological age. The Ottawa GRS assesses non-technical CRM skills on a 7-point scale (minimum 1, maximum 7), with higher scores indicating better performance.
CRM Performance During First Sim Scenario Assessed by ACLS Checklist
Time frame: After managing first simulation scenario - Day 1
ACLS (Advanced Cardiac Life Support) score will be correlated with chronological age. Items on the checklist were separated into two components: 1) the ACLS correct score (minimum score 0, maximum score 30), where higher scores indicate better performance, and 2) the ACLS risk score (minimum score 0, maximum score 17) where higher scores indicate worse performance.
2 secondary outcomes
Learning From High-fidelity Simulation Education Assessed by Ottawa Global Rating Scale
Time frame: After managing second simulation scenario - Day 1
Learning From High-fidelity Simulation Education Assessed by ACLS Checklist
Time frame: After managing second simulation scenario - Day 1
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Jan 2025.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Background: PubMed 11375831Katz JD. Issues of concern for the aging anesthesiologist. Anesth Analg. 2001 Jun;92(6):1487-92. doi: 10.1097/00000539-200106000-00027. No abstract available.
- Background: PubMed 24985937Baxter AD, Boet S, Reid D, Skidmore G. The aging anesthesiologist: a narrative review and suggested strategies. Can J Anaesth. 2014 Sep;61(9):865-75. doi: 10.1007/s12630-014-0194-x. Epub 2014 Jul 2.
- Background: PubMed 26291778Baird M, Daugherty L, Kumar KB, Arifkhanova A. Regional and Gender Differences and Trends in the Anesthesiologist Workforce. Anesthesiology. 2015 Nov;123(5):997-1012. doi: 10.1097/ALN.0000000000000834.
- Background: PubMed 20736429Siu LW, Boet S, Borges BC, Bruppacher HR, LeBlanc V, Naik VN, Riem N, Chandra DB, Joo HS. High-fidelity simulation demonstrates the influence of anesthesiologists' age and years from residency on emergency cricothyroidotomy skills. Anesth Analg. 2010 Oct;111(4):955-60. doi: 10.1213/ANE.0b013e3181ee7f4f. Epub 2010 Aug 24.
- Background: PubMed 28083205Daugherty L, Fonseca R, Kumar KB, Michaud PC. An Analysis of the Labor Markets for Anesthesiology. Rand Health Q. 2011 Sep 1;1(3):18. eCollection 2011 Fall.
- BackgroundDuke, E. (2006). The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians : Report to Congress (p. 36). U.S. Department of Health & Human Sciences.
- Background: PubMed 20872769Durning SJ, Artino AR, Holmboe E, Beckman TJ, van der Vleuten C, Schuwirth L. Aging and cognitive performance: challenges and implications for physicians practicing in the 21st century. J Contin Educ Health Prof. 2010 Summer;30(3):153-60. doi: 10.1002/chp.20075.
- Background: PubMed 12377689Eva KW. The aging physician: changes in cognitive processing and their impact on medical practice. Acad Med. 2002 Oct;77(10 Suppl):S1-6. doi: 10.1097/00001888-200210001-00002. No abstract available.
- Background: PubMed 11245381Trunkey DD, Botney R. Assessing competency: a tale of two professions. J Am Coll Surg. 2001 Mar;192(3):385-95. doi: 10.1016/s1072-7515(01)00770-0. No abstract available.
- Background: PubMed 10693852Turnbull J, Carbotte R, Hanna E, Norman G, Cunnington J, Ferguson B, Kaigas T. Cognitive difficulty in physicians. Acad Med. 2000 Feb;75(2):177-81. doi: 10.1097/00001888-200002000-00018.
- Background: PubMed 18004990Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Educ. 2007 Dec;41(12):1140-5. doi: 10.1111/j.1365-2923.2007.02914.x. Epub 2007 Nov 13.
- Background: PubMed 22354239Tessler MJ, Shrier I, Steele RJ. Association between anesthesiologist age and litigation. Anesthesiology. 2012 Mar;116(3):574-9. doi: 10.1097/ALN.0b013e3182475ebf.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Fahad Alam, MD, FRCPC principal investigator
Sunnybrook Health Sciences Centre
Sylvain Boet, MD, MEd, PhD principal investigator
University of Ottawa
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Ageing, run by Sunnybrook Health Sciences Centre at 2 sites in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 20 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 20 Jan 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
CRM Performance During First Sim Scenario Assessed by Ottawa Global Rating Scale (GRS) (time frame: After managing first simulation scenario - Day 1). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02683447, which also lists 25 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Jan 2025.