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Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study

Background and Objectives: Medical staff is rarely trained in structured decision-making, relying instead on intuition without due consideration for the associated pros and cons. Materials and Methods: We adopted a model for decision-making to improve reasoning and risk assessment and carried out a...

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Autores principales: Häske, David, Dorau, Wolfgang, Heinemann, Niklas, Stock, Jan-Philipp, Schempf, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680916/
https://www.ncbi.nlm.nih.gov/pubmed/31277516
http://dx.doi.org/10.3390/medicina55070339
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author Häske, David
Dorau, Wolfgang
Heinemann, Niklas
Stock, Jan-Philipp
Schempf, Benjamin
author_facet Häske, David
Dorau, Wolfgang
Heinemann, Niklas
Stock, Jan-Philipp
Schempf, Benjamin
author_sort Häske, David
collection PubMed
description Background and Objectives: Medical staff is rarely trained in structured decision-making, relying instead on intuition without due consideration for the associated pros and cons. Materials and Methods: We adopted a model for decision-making to improve reasoning and risk assessment and carried out a prospective simulation study using paramedic students in a three-year training program. We conducted a training session in which participants were lectured on decision-making using the FAR-BEK model (German abbreviation for facts, alternatives, risks, competence, decision, control), physiological processes in decision-making under stress, as well as medico-legal aspects for the comprehension and justification of medical decisions. We analyzed pre- and post-training scenarios to elucidate the influence of training on decision-making. Results: Twenty paramedic students, with a mean age of 22.0 ± 1.7 years, took part in the study. The question of whether decision aids can be applied, initially affirmed by 40% of participants, rose to 71.4% (p = 0.011) following our training. Confidence in decision-making increased on a 7-point Likert scale from 4.5 to 4.8 points (p < 0.394). The reasoning behind the decisions rose from 5.3 to 5.6 points (p < 0.081). Indication, options, and risks rose significantly, from 5.4 to 6.1 points (p = 0.045). Overall, our simulation training significantly increased the points of decision support taken into account (57.8% vs. 88.9%, p < 0.001). Viewed individually, the largest increase of 180% was seen in risk assessment (33.3% vs. 93.3%, p < 0.002). The second largest increase of 150% was seen in the question of one’s own permissions (26.7% vs. 66.7%, p < 0.066). Also, the control increased (40.0% vs. 86.7%, p < 0.021). Conclusions: With a brief training course, both the awareness and the implementation of a structured decision-making model in paramedic students can be significantly increased. Nevertheless, no definitive conclusions can be made with respect to the implementation of real patient care. The application of structured, standardized decision-making tools may need to be further consolidated in routine medical use.
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spelling pubmed-66809162019-08-09 Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study Häske, David Dorau, Wolfgang Heinemann, Niklas Stock, Jan-Philipp Schempf, Benjamin Medicina (Kaunas) Article Background and Objectives: Medical staff is rarely trained in structured decision-making, relying instead on intuition without due consideration for the associated pros and cons. Materials and Methods: We adopted a model for decision-making to improve reasoning and risk assessment and carried out a prospective simulation study using paramedic students in a three-year training program. We conducted a training session in which participants were lectured on decision-making using the FAR-BEK model (German abbreviation for facts, alternatives, risks, competence, decision, control), physiological processes in decision-making under stress, as well as medico-legal aspects for the comprehension and justification of medical decisions. We analyzed pre- and post-training scenarios to elucidate the influence of training on decision-making. Results: Twenty paramedic students, with a mean age of 22.0 ± 1.7 years, took part in the study. The question of whether decision aids can be applied, initially affirmed by 40% of participants, rose to 71.4% (p = 0.011) following our training. Confidence in decision-making increased on a 7-point Likert scale from 4.5 to 4.8 points (p < 0.394). The reasoning behind the decisions rose from 5.3 to 5.6 points (p < 0.081). Indication, options, and risks rose significantly, from 5.4 to 6.1 points (p = 0.045). Overall, our simulation training significantly increased the points of decision support taken into account (57.8% vs. 88.9%, p < 0.001). Viewed individually, the largest increase of 180% was seen in risk assessment (33.3% vs. 93.3%, p < 0.002). The second largest increase of 150% was seen in the question of one’s own permissions (26.7% vs. 66.7%, p < 0.066). Also, the control increased (40.0% vs. 86.7%, p < 0.021). Conclusions: With a brief training course, both the awareness and the implementation of a structured decision-making model in paramedic students can be significantly increased. Nevertheless, no definitive conclusions can be made with respect to the implementation of real patient care. The application of structured, standardized decision-making tools may need to be further consolidated in routine medical use. MDPI 2019-07-04 /pmc/articles/PMC6680916/ /pubmed/31277516 http://dx.doi.org/10.3390/medicina55070339 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Häske, David
Dorau, Wolfgang
Heinemann, Niklas
Stock, Jan-Philipp
Schempf, Benjamin
Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study
title Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study
title_full Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study
title_fullStr Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study
title_full_unstemmed Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study
title_short Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study
title_sort development of an adapted model for decision-making to improve reasoning and risk assessment in an emergency team: a prospective simulation study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680916/
https://www.ncbi.nlm.nih.gov/pubmed/31277516
http://dx.doi.org/10.3390/medicina55070339
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