The Creation of Shared Mental Models in Simulation Training Enhances Quality of Resuscitation: A Randomized Controlled Study.

Abstract

Objectives: This study aimed to enhance the quality of Advanced Cardiac Life Support (ACLS) training, with quality defined as the combination of technical skills (TS) and non-technical skills (NTS), by addressing the gap in effective methods for developing NTS through simulation-based medical education (SBME). Specifically, it sought to develop and evaluate a strategy for establishing shared mental models (SMM) and fostering trust among team members during undergraduate emergency training.

Methods: This study was conducted during mandatory ACLS undergraduate simulation training sessions. The control group participated in traditional, teacher-led classes and debriefings, while the intervention group received training incorporating SMM as the intervention. The study evaluated the quality of cardiopulmonary resuscitation as the primary outcome, encompassing both TS and NTS. Additionally, changes in undergraduate situational motivation, assessed within the framework of self-determination theory, and subjective learning gains were analyzed.

Results: The control group demonstrated a significant improvement in TS (P = .030), while the intervention group did not (P = .078). Conversely, the intervention group showed a significant improvement in NTS (P = .01; 95% confidence interval [0.296, 2.17]), whereas the control group did not (P = .105). The motivational changes of both groups were comparable, reflecting high levels of autonomous motivation. Both groups also reported significant learning gains.

Conclusion: This study demonstrates that SBME is highly effective for teaching TS. However, it is crucial to incorporate advanced instructional methods focusing on NTS. One promising approach is the development of SMM. Based on our results, hands-on practice remains essential and should not be restricted to theoretical or conceptual training. A balanced combination of advanced didactic techniques and practical application ensures that learners develop both, TS and NTS. SBME and the development of SMM equally address both the motivational and content dimensions of learning, enhancing student engagement while effectively conveying essential knowledge and skills.