Automated Debriefing in Simulation-based Training of Paramedics: Comparing Self-guided to Agent Facilitated Debriefing

新冠肺炎疫情突显了对护理人员和其他紧急医疗服务提供者的需求，例如紧急医疗技术人员(EMT)。这些急救人员可以让呼吸困难的人保持活着，直到他们到达医院并得到持续的护理，包括必要时呼吸呼吸机的支持。该项目的重点是护理人员，他们在院前护理方面接受过最高水平的培训。除了使用支持呼吸的呼吸道设备外，护理人员还可以使心脏病发作的受害者苏醒，接生无法等待母亲到达医院的婴儿，给他们用药，并执行其他维持生命的程序。不幸的是，美国许多地区的护理人员严重短缺，这在一定程度上是由于学生未能通过护理人员培训计划，或者无法通过州和国家认证考试。该项目将开发一种手持平板设备，允许一小群护理专业的学生在病人人体模型上进行院前护理程序的额外练习。这些补充练习课程将完全由学生管理。学生将从他们的课程网站下载脚本化的紧急情况场景。一名学生将扮演首席护理人员的角色，另一名学生将扮演协助护理人员的EMT的角色，而第三名学生将使用平板电脑来检查操作(例如，检查血压)并报告这些操作的结果(例如，血压为80/50)。所有行动都将被记录在日志中，该日志将生成自动汇报；即，对学生在场景中的表现的反馈。增加学生在培训期间练习技能的机会可能会提高辅助医疗项目和认证考试的通过率。准备更充分的护理人员也将提高患者的安全。项目结果可能会推广到其他医疗保健提供者的培训，如医生、护士和医生助理。本项目将侧重于通常在基于模拟的培训(SBT)练习之后的汇报，当学生根据训练有素的辅导员的反馈反思他们的表现时。尽管对SBT的元评价表明，汇报可能是其最关键的组成部分，但指导汇报实践的研究很少。这个项目将有助于填补这一空白。研究小组将实施并比较三种自动汇报方法的有效性。其中一个版本将复制当前最先进的自动任务汇报，学生可以滚动浏览事件日志，其中嵌入了关于他们在场景中的行为的文本反馈。这种汇报方式不遵循汇报的标准化协议(脚本)。第二个版本遵循汇报协议，其首字母缩写为DELBrief(定义汇报规则；解释学习目标；指定绩效基准；回顾应该发生的事情；确定实际发生的事情；检查原因；以及正式确定带回家的要点)。这一版本的自动汇报模拟了学生自我指导的汇报。系统将提示学生完成汇报方案步骤，但不会提供反馈。第三个版本将模拟人工协助的任务汇报。根据DeBrief的说法，两个自动化代理，一名调解员和一名同行，将支持在练习场景中扮演首席护理人员角色的学生进行富有成效的汇报。主要的技术创新将是开发管理这些模拟代理人(促进者和同伴)与人类辅助医疗学生之间的互动的方法。该项目包括三个主要阶段。首先，为了告知代理人促进的汇报系统的实施情况，研究小组将观察并录像实际的SBT情景和汇报，这些情景和汇报发生在匹兹堡大学急诊医学中心的辅助医疗培训期间。其次，研究人员将反复开发、现场测试和改进每个版本的汇报系统。第三，研究人员将进行随机对照试验，以比较这些自动汇报方法在改善精神运动技能(例如，心肺复苏)和决策技能方面的潜力。研究结果可能会推广到其他医疗保健专业人员的基于模拟的培训，以及在培训中汇报起主要作用的任何领域。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

The COVID-19 pandemic has highlighted the need for paramedics and other emergency medical service providers, such as emergency medical technicians (EMTs). These first responders can keep a person who is struggling to breathe alive until they arrive at a hospital and receive sustained care, including support from a respiratory ventilator if necessary. This project focuses on paramedics, who have the highest level of training in pre-hospital care. In addition to utilizing airway devices that support breathing, paramedics can revive a heart attack victim, deliver a baby who cannot wait for his/her mother to get to the hospital, administer medications, and perform other life-sustaining procedures. Unfortunately, there is a critical shortage of paramedics in many parts of the US, which is partly due to student failure from paramedic training programs, or inability to pass state and national certification exams. This project will develop a handheld tablet device that will allow small groups of paramedic students to get extra practice in performing pre-hospital care procedures on patient manikins. These supplemental practice sessions will be entirely student-run. Students will download scripted emergency scenarios from their course web site. One student will play the role of lead paramedic, another student will play the role of an EMT who assists the paramedic, while a third student will use the tablet to check off actions (e.g., Checked blood pressure) and to report the results of these actions (e.g., Blood pressure is 80/50). All actions will be recorded in a log that will produce an automated debriefing; that is, feedback on student performance during the scenario. Increased opportunities for students to practice skills during training could raise pass rates from paramedic programs and on certification exams. Better-prepared paramedics will also increase patient safety. Project findings might generalize to training of other healthcare providers such as doctors, nurses, and physician assistants.This project will focus on the debriefing that typically follows a simulation-based training (SBT) exercise, when students reflect on their performance with feedback from a trained facilitator. Although meta-reviews of SBT indicate that debriefing may be its most critical component, there is a dearth of research to guide debriefing practice. This project will help to fill this void. The research team will implement and compare the effectiveness of three approaches to automated debriefing. One version will replicate the current state-of-the-art in automated debriefing, whereby students scroll through an event log with embedded textual feedback on their actions during the scenario. This approach to debriefing does not follow a standardized protocol (script) for debriefing. The second version follows a debriefing protocol whose acronym is DEBRIEF (for Define the debriefing rules; Explain the learning objectives; specify the performance Benchmarks; Review what was supposed to happen; Identify what actually happened; Examine why; and Formalize the take home points). This version of automated debriefing simulates student self-guided debriefing. The system will prompt the student to go through the DEBRIEF protocol steps but will not provide feedback. The third version will simulate human facilitated debriefing. Two automated agents, a facilitator and a peer, will support the student who played the role of lead paramedic during a practice scenario in carrying out a productive debriefing, according to DEBRIEF. The main technological innovation will be development of methods to manage the interaction between these simulated agents (facilitator and peer) and the human paramedic student. The project consists of three main phases. First, to inform implementation of the agent facilitated debriefing system, the research team will observe and video record actual SBT scenarios and debriefings that take place during paramedic training at the University of Pittsburgh, Center for Emergency Medicine. Second, the researchers will iteratively develop, field test, and refine each version of the debriefing system. Third, the researchers will conduct a randomized controlled trial to compare the potential of these approaches to automated debriefing to improve psychomotor skills (e.g., cardiopulmonary resuscitation) and decision-making skills. Study findings might generalize to simulation-based training of other healthcare professionals and to any field in which debriefing plays a major role in training.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.