Isaranuwatchai Wanrudee, Alam Fahad, Hoch Jeffrey, Boet Sylvain
Centre for Excellence in Economic Analysis Research, The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Ontario, Canada.
Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
J Educ Eval Health Prof. 2016 Dec 26;13:44. doi: 10.3352/jeehp.2016.13.44. eCollection 2017.
High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other.
This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve.
Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative.
With a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.
高保真模拟训练对于学习危机资源管理（CRM）技能是有效的，但成本是将高保真模拟训练纳入课程的主要障碍。本研究的目的是检验自我总结汇报和传统教师总结汇报在CRM培训项目中的成本效益，并计算当一种总结汇报类型比另一种更具成本效益时的最低支付意愿（WTP）值。
本研究使用了来自加拿大一项涉及50名麻醉科住院医师的随机对照试验的先前数据。每位参与者应对一个测试前的危机场景。被随机分配到自我总结汇报组的参与者在总结汇报时观看他们测试前场景的视频，且没有教师在场。对照组的参与者由一名经过培训的教师使用他们测试前场景的视频进行总结汇报。参与者分别应对一个测试后的模拟危机场景。我们使用净效益回归比较了自我总结汇报与教师总结汇报的成本和效果。成本效益估计以增量净效益报告，不确定性通过成本效益可接受性曲线呈现。
自我总结汇报的成本低于教师总结汇报。随着WTP的增加，自我总结汇报具有成本效益的概率降低。当WTP≤200加元时，自我总结汇报项目具有成本效益。然而，当效果的定价高于成本节约且WTP>300加元时，教师总结汇报是更优选择。
当WTP较低（≤200加元）时，在CRM模拟训练中，与教师总结汇报相比，自我总结汇报具有成本效益。本研究提供了有关成本效益的证据，这将为决策者和临床教育工作者的决策过程提供参考，并可能有助于优化教育资源的分配。
Zotero 插件