Trainees were selected from the “Health Emergency ReAction Team (HEAT)” of the First Affiliated Hospital of SYSU. Thirty-eight trainees were planned to recruit based on their departments and specialties. 38 participants were planned to be divided into 3 groups (12-13 per group), and each group received the 4-day identical training course. It would be taken 12 days for all trainees to complete the training
The major training equipment included 2 sets of ECMO equipment: PLS set system (MAQUET, Germany) and HLS Module Advanced system (MAQUET, Germany)), high-fidelity simulation system (CALIFIA simulation system (Biomed Simulation, Inc., USA)).
According to the “ELSO guidelines for training and continuing education” framework,, the curriculum consisted of didactic course, priming ECMO circuit, water-drills practice, and emergency ECMO scenarios performed with high-fidelity simulation system.(Figure 1).
The ECMO training course was designed over a 4-day period. The first day was didactic lectures, followed by a full day of priming training, simulation training took place at the third day. And the practical examination was arranged on the last day.
According to the “ELSO guidelines for training and continuing education” framework, purpose-designed basic ECMO theory focused on the following content: the characteristics of pathophysiology and hemodynamics in severe ARDS patients with ECMO, cannulation, indications and contraindications for severe ARDS patients , management and weaning circuit.
3.2 Construction and development high-fidelity simulation scenarios
The platform for simulated situational teaching was constructed at the simulated ICU lab in the clinical teaching center of the First Affiliated Hospital, SYSU. By remodeling an adult cardio-pulmonary resuscitation (CPR) model, a mannequin model, a ECMO and venovenous ECMO circuit, the “patient module” of the CAFILIA system, and the CAFILIA simulation operating system were connected with a monitoring instrument to construct the ECMO simulation. In order to reflect immediate changes to vital parameters for the ECMO scenarios, the simulator system was operated remotely via CAFILIA central control console and completed of setting preprogrammed. The vital signs and lab data were displayed on a monitor which have been preprogrammed already and in accordance with the given scenario.
To make the scenarios more authentic and optimize the clinical experience , five scenarios were designed by the experienced and well-trained ECMO experts (Supplemental table 1). The team or the individual trainee should notice the abnormal vital sign and lab data from the monitor, check the human model and ECMO circuit, the ECMO machine also should be take into consideration. Simulation scenario was controlled by the clinical teaching center colleagues and was synchronized with the interventions. Also, we had a medical volunteer assist with any practical aspects and provide additional information for the context of the scene. The volunteer received a half-day of training before the training course started.
12-13 participants were divided into 4 teams, with at least 1 physician in each team. Extensive debriefing followed each scenario.
4.Assessment and Evaluation
At the end of the course, the participants were required to past a 60min written test. This test was comprised of 50 multiple choice questions (MCQ) based on the didactic course. In the practical test, each team selected a simulated scenario randomly from Supplemental table 1 and the whole exam process was videotaped.
Four ECMO well-trained and experienced ICU experts judged the performance for each participant during the practical test with predesigned specific trigger events and expected interventions. These four experts were blinded to each other’s judgements. They used a 5-point Likert scale to assess the participants’ performance. The score for each evaluation item ranged from 1 to 5, with 1 being the lowest and 5 being the best; the total score was 50 (table 2).
Pre-simulation test questionnaire was an evaluation of trainees for the authenticity of the simulation circumstance (Supplemental Table 2), and post-simulation test questionnaire was formulated based on ELSO’s training guidelines and the teaching objectives of the course, which were also the trainees’ self-judgments (Supplemental Table 3). Each question ranged from 1 to 10, with 1 being the poorest and 10 being the best.
The 5-point Likert scale and the questionnaires were formulated based on the “Guidelines for training and continuing education” and “The Mayo High Performance Teamwork Scale”.
The primary outcome of this study was to evaluate whether integration both traditional teaching and high fidelity simulation teaching can improve the technical and non-technical skills of novice health workers , enable them to accurately recognize the emergencies , and solve the problems effectively.
The secondary objective was to determine if the training can improve novices’ confidence and nontechnical behaviors when facing complicated ECMO management.
SPSS (IBM Statistical Package for Social Sciences v21.0; Chicago) was used for the statistical analysis. Continuous variables are expressed as the median and interquartile ranges (IQR 25-75%). Discrete variables are expressed as percentages.