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Letter to the Editor

Highlighting Instructional Design Features in Reporting Guidelines for Health Care Simulation Research

Cheng, Adam MD, FRCPC; Nadkarni, Vinay M. MD; Chang, Todd P. MD; Auerbach, Marc MD, MSc

Author Information
doi: 10.1097/SIH.0000000000000202

Dear Editor

In a commentary entitled “Reporting Guidelines for Health Care Simulation Research: Where is the Learning”,1 Dr. E. Salas correctly highlights the vital importance of describing the instructional features of learning when publishing simulation-based educational research. He succinctly lists a number of critically important elements of simulation-based instructional design, including: feedback and debriefing, learning objectives, scenario development (and associated triggers), and performance assessment. Dr. Salas expresses concern that the recently published reporting guidelines for health care simulation research2–5 do not adequately emphasize or include these key elements of simulation research.

We agree with Dr. Salas and his assertion that instructional design features of simulation-based educational interventions are of paramount importance. Of note, we previously championed this concept in a separate manuscript on simulation-based research.6 The project to develop reporting guidelines for health care simulation research involved designing extensions to both the Consolidated Standards of Reporting Trials (CONSORT)7 and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)8 Statements. In an effort to maintain consistency in form and function with previously published versions of the CONSORT and STROBE statements and checklists, we elected not to add new items to each list, but rather build on existing items with simulation-specific extensions.

We agree with Dr. Salas’s commentary that “a fundamental aspect of simulation-based research is to determine what works best for training purposes.”1 To emphasize the importance of reporting specific instructional design features of the simulation-based educational intervention, we published a table featuring Key Elements to Report for Simulation-based Research (Table 3) in the reporting guidelines manuscripts.2–5 This table serves as an additional checklist to report items specific to simulation-based research, and is meant to supplement item 5 (interventions) on the CONSORT Statement and item 7 (variables) on the STROBE Statement. Key elements include the following: (1) participant orientation, (2) simulation type, (3) simulation environment, (4) simulation event/scenario, (5) instructional design or exposure and (6) feedback and/or debriefing. Each key element has associated sub-elements and descriptors that can be used to help investigators design and report simulation-based research. The importance of outcomes and methods of assessment are highlighted with new simulation-specific extensions for item 6 (outcomes) of the CONSORT Statement and item 8 (data sources/measurement) of the STROBE Statement. Thus, we believe that critical elements of instructional design are indeed incorporated into the current CONSORT and STROBE statements for health care simulation research.2–5

For illustration, the element “feedback and/or debriefing” has 9 sub-elements: source, duration, facilitator presence, facilitator characteristics, content, structure/method, timing, video and scripting. A study describing the impact of a debriefing intervention should describe each of these sub-elements in detail, and make note if these sub-elements were not used (eg. debriefing script) in the study. Some elements and/or sub-elements may not be applicable to all studies. For further detail, we refer readers to the explanation and elaboration document published as part of the reporting guidelines, found at http://links.lww.com/SIH/A266 (Explanation and Elaboration of the Simulation-Specific Extensions for the CONSORT and STROBE Statements). This document provides illustrative examples for how to report items with new extensions, including item 5 (interventions) of the CONSORT Statement and item 7 (variables) of the STROBE Statement. Simulation-based research scientists are encouraged to be thorough but appropriately selective when reporting their educational interventions using this table.

Whereas the table of key elements is not part of either the CONSORT or STROBE checklists, we encourage authors, reviewers, and editors to use the table as a separate checklist when writing or reviewing papers describing simulation-based educational research. We invite the simulation research community to provide feedback on these elements at http://inspiresim.com/simreporting/so that we can work toward modification of the reporting guidelines in the future. As Dr. Salas states, these instructional design features “are critical to improve the science of simulation”.1

Sincerely yours,

Adam Cheng, MD, FRCPC

University of Calgary

KidSim-ASPIRE Research Program

Division of Emergency Medicine

Department of Pediatrics

Alberta Children’s Hospital

2888 Shaganappi Trail NW, Calgary

Alberta, Canada

chenger@me.com

Vinay M. Nadkarni, MD

Department of Pediatrics

Children’s Hospital of Philadelphia

University of Pennsylvania Perelman

School of Medicine

Todd P. Chang, MD

Department of Pediatrics

Children’s Hospital of Los Angeles

University of Southern California

Marc Auerbach, MD, MSc

Department of Pediatrics

Section of Emergency Medicine

Yale University School of Medicine

ACKNOWLEDGMENT

The authors acknowledge several other original authors of the reporting guidelines manuscript who reviewed this letter to the editor: David Kessler, Ralph Mackinnon, Joshua Hui, and Betsy Hunt.

REFERENCES

1. Salas E. Reporting Guidelines for Health Care Simulation Research: Where Is the learning? Simul Healthc 2016;11(4):249.
2. Cheng A, Kessler D, Mackinnon R, et al. Reporting guidelines for health care simulation research: Extensions to the CONSORT and STROBE statements. Simul Healthc 2016. DOI: 10.1136/bmjstel-2016-000124.
3. Cheng A, Kessler D, Mackinnon R, et al. Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements. Advances in Simulation 2016;1(1).
4. Cheng A, Kessler D, Mackinnon R, et al. Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements. Simul Healthc 2016;11(4):238–248.
5. Cheng A, Kessler D, Mackinnon R, et al. Reporting guidelines for health care simulation research. Clinical Simulation in Nursing 2016;12(8):iii–xiii.
6. Cheng A, Auerbach M, Chang T, et al. Designing and conducting simulation-based research. Pediatrics 2014;133(6):1091–1101.
7. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001;357(9263):1191–1194.
8. von Elm E, Altman DG, Egger M, et al. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Ann Intern Med 2007;147:573–577.

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