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It is challenging for healthcare team to manage emergency patient effectively. Most of these critical patients have medical conditions and need complex medical managements. Research findings have shown that poor healthcare teamwork would result in poor communication, missing information, and insufficient situation monitoring and thus compromise patient safety. Simulation has been proved as an effective method to develop teamwork competency. However, comparing to traditional training model, simulation requires more resources such as funding, spaces, time, administration staffs, schedule, facilitators, and equipment. It would not be easy to delivery in various professional departments. Game-based learning was a known effective and learner-centered learning model which required less resources. Researchers have shown that game-based learning has higher acceptance for the learners and can improve learners' knowledge, attitude, motivation, and performance. Therefore, the aim of this study was to explore the learning effectiveness of resuscitation teamwork training of board game-based learning, simulation-based learning and lecture-based learning in PGY doctors and nurses.
This will be a prospective, longitudinal, and randomized controlled trial design. A total number of 180 PGY doctors and nurses will be enrolled from a teaching hospital in northern Taipei City. They will be randomized into board game-based learning group, simulation-based learning group, and lecture-based learning group. Three groups will receive "Emergency Medical Response Teamwork" training and all of these contents were developed according to America Heart Association Guidelines for Cardiopulmonary Resuscitation and ECC and TeamSTEPPS curriculum from Agency for Healthcare Research and Quality. We will collect the professional demography, the professional medical knowledge for medical management, the concept of knowledge for teamwork, team performance, team attitude, medical management, course survey, and cognitive load scales. We will compare the learning effectiveness between three groups in pretest, posttest, and three-months follow up. Statistical methods used included descriptive and inferential statistics, χ2 chi-square tests, Kruskal-Wallis H test, Friedman test, Wilcoxon test, generalized estimating equations, and text mining.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Board game-based learning (experience group-I) | Experimental | The team of PGY doctors and nurses receive training in resuscitation teamwork skills through a board game-based teaching approach. |
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| Simulation-based learning (experience group-II) | Experimental | The team of PGY doctors and nurses receive training in resuscitation teamwork skills through a simulation-based teaching approach. |
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| Lecture-based learning (control group) | Other | The team of PGY doctors and nurses receive training in resuscitation teamwork skills through an interactive lecture-based learning approach. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Board game-based learning | Behavioral | The team of PGY doctors and nurses received 3 hours training intervention in resuscitation teamwork skills through a board game-based teaching approach. |
| Measure | Description | Time Frame |
|---|---|---|
| Team Performance Observation Tool | The assessment of the medical team's teamwork performance was conducted using the Team Performance Observation Tool, which includes a 23-item rating checklist. This checklist is divided into five categories: team structure (four items), leadership (six items), communication (four items), situation monitoring (five items), and mutual support (four items). Scores for each item range from 1 (Very Poor) to 5 (Excellent), resulting in a cumulative score between 23 and 115. A higher score indicates better teamwork performance. | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
| Knowledge of Teamwork Assessment | The "Knowledge of Teamwork" assessment, aimed at evaluating healthcare professionals' understanding of teamwork knowledge, consists of 23 multiple-choice items based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) Learning Benchmarks provided by the Agency for Healthcare Research and Quality. Each item is formulated as a statement that participants must evaluate as true or false, choosing from five available answer options, of which only one is correct. Participants earn one point for each correct response, with no points awarded for incorrect answers, resulting in a total possible score of 0 to 23. A higher score signifies a more comprehensive understanding of the principles of teamwork knowledge. | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Interprofessional Collaboration Scale | The attitudes of healthcare professionals toward interprofessional collaboration were assessed using the 'Interprofessional Collaboration Scale' (IPC), which consists of 26 items. The Interprofessional Collaboration Scale covers three main aspects: communication, accommodation, and isolation. We adopted the first 13 items because they are relevant to medical and nursing professional backgrounds. The scale ranges from 1 (strongly disagree) to 4 (strongly agree), with total scores ranging from 13 to 52. A higher score indicates a more positive attitude toward interprofessional collaboration. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jen-Chieh Wu | Taipei Medical University Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jen-Chieh Wu | New Taipei City | 23442 | Taiwan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32404076 | Background | Aboalshamat K, Khayat A, Halwani R, Bitan A, Alansari R. The effects of gamification on antimicrobial resistance knowledge and its relationship to dentistry in Saudi Arabia: a randomized controlled trial. BMC Public Health. 2020 May 13;20(1):680. doi: 10.1186/s12889-020-08806-2. | |
| 26323885 | Background | Al-Ghareeb AZ, Cooper SJ. Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review. Nurse Educ Today. 2016 Jan;36:281-6. doi: 10.1016/j.nedt.2015.08.005. Epub 2015 Aug 19. |
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The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48.
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| ID | Title | Description |
|---|---|---|
| FG000 | Board Game-based Learning | The team of PGY doctors and nurses received training in resuscitation teamwork skills through a board game-based teaching approach. |
| FG001 | Simulation-based Learning | The team of PGY doctors and nurses received training in resuscitation teamwork skills through a simulation-based teaching approach. |
| FG002 | Lecture-based Learning | The team of PGY doctors and nurses received training in resuscitation teamwork skills through an interactive lecture-based learning approach. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pretest to Posttest |
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| Posttest to Three Months Follow-up |
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| ID | Title | Description |
|---|---|---|
| BG000 | Board-game Based Learning | The team of PGY doctors and nurses received training in resuscitation teamwork skills through a board game-based teaching approach. |
| BG001 | Simulation-based Learning |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Team Performance Observation Tool | The assessment of the medical team's teamwork performance was conducted using the Team Performance Observation Tool, which includes a 23-item rating checklist. This checklist is divided into five categories: team structure (four items), leadership (six items), communication (four items), situation monitoring (five items), and mutual support (four items). Scores for each item range from 1 (Very Poor) to 5 (Excellent), resulting in a cumulative score between 23 and 115. A higher score indicates better teamwork performance. | The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak. | Posted | Median | Inter-Quartile Range | score on a scale | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks.
The study focused on assessing learning effectiveness, using educational procedures as both the assessment and intervention, without involving any invasive medical procedures or medical treatment. In the Adverse Event Reporting, regarding the monitoring/assessment of all-cause mortality, serious, or other (non-serious) adverse events, none of the participants experienced any adverse events throughout the study.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Board-game Based Learning | The team of PGY doctors and nurses, including total 32 participants, received 3 hours training intervention in resuscitation teamwork skills through a board game-based teaching approach. The intervention itself is an educational procedure, which is not including a medical treatment. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Hui-Wen Chen Phd candidate | National Yang Ming Chiao Tung University, Department of Nursing | +886939947807 | m513102001@gmail.com |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 23, 2022 | Mar 26, 2024 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D035061 | Control Groups |
| ID | Term |
|---|---|
| D015340 | Epidemiologic Research Design |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D012107 | Research Design |
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three arms
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two assessors using video to evaluate outcomes.
|
| Simulation-based learning | Behavioral | The team of PGY doctors and nurses received 3 hours training intervention in resuscitation teamwork skills through a simulation-based teaching approach. |
|
|
| Lecture-based learning | Behavioral | The team of PGY doctors and nurses received 3 hours training intervention in resuscitation teamwork skills through an interactive lecture-based approach. |
|
|
| Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
| Resuscitation Knowledge Scale | The healthcare professionals' resuscitation medical knowledge was assessed using the 'Adavance Cardiac Life Support Precourse Self-Assessment,' which consisted of 60 items. The assessment covered three main aspects: rhythm identification, pharmacology, and practical application. We selected 20 items related to resuscitation medical management (ventricular tachycardia, ventricular fibrilation, asystole, pulseless electrical activity). The total score ranged from 0 (minimum) to 20 (maximum), with higher scores indicating a better understanding of resuscitation medical knowledge. | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
| Medical Task Performance | The medical team's resuscitation management performance was assessed using the "Medical Task Performance" checklist. The checklist items were referenced from the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Twenty items were identified by an expert panel based on the resuscitation guidelines, including applying adequate oxygen according to the patient's dynamic condition, timely identification of cardiac arrest and provision of high-quality cardiopulmonary resuscitation, identification of shockable rhythms and delivery of timely and correct shocks, and correct administration of resuscitation medication. The checklist was rated on a dichotomous scale with scores of 2 (complete), 1 (partial), and 0 (incomplete). The total score ranged from 0 (minimum) to 40 (maximum), with higher scores indicating better resuscitation management performance by the medical team. | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
| Learning Cognitive Load | The learning cognitive load of healthcare professionals was assessed using the 'Chinese Version of the Learning Cognitive Load Questionnaire,' which consists of 8 items. The questionnaire encompasses two main aspects: mental load and mental effort. The scale ranges from 1 (Strongly Disagree) to 6 (Strongly Agree), with a total score from 6 (minimun) to 48 (maximun). A higher score indicates a higher learning cognitive load. | The posttest right after intervention at the 4 weeks. |
| 32873285 | Background | Buijs-Spanjers KR, Harmsen A, Hegge HH, Spook JE, de Rooij SE, Jaarsma DADC. The influence of a serious game's narrative on students' attitudes and learning experiences regarding delirium: an interview study. BMC Med Educ. 2020 Sep 1;20(1):289. doi: 10.1186/s12909-020-02210-5. |
| 21156305 | Background | Capella J, Smith S, Philp A, Putnam T, Gilbert C, Fry W, Harvey E, Wright A, Henderson K, Baker D, Ranson S, Remine S. Teamwork training improves the clinical care of trauma patients. J Surg Educ. 2010 Nov-Dec;67(6):439-43. doi: 10.1016/j.jsurg.2010.06.006. Epub 2010 Nov 5. |
| 18828831 | Background | Fernandez R, Kozlowski SW, Shapiro MJ, Salas E. Toward a definition of teamwork in emergency medicine. Acad Emerg Med. 2008 Nov;15(11):1104-12. doi: 10.1111/j.1553-2712.2008.00250.x. Epub 2008 Oct 1. |
| 27532314 | Background | Eddy K, Jordan Z, Stephenson M. Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature. JBI Database System Rev Implement Rep. 2016 Apr;14(4):96-137. doi: 10.11124/JBISRIR-2016-1843. |
| 30766862 | Background | Cutumisu M, Patel SD, Brown MRG, Fray C, von Hauff P, Jeffery T, Schmolzer GM. RETAIN: A Board Game That Improves Neonatal Resuscitation Knowledge Retention. Front Pediatr. 2019 Jan 31;7:13. doi: 10.3389/fped.2019.00013. eCollection 2019. |
| 28370414 | Background | Malmstrom B, Nohlert E, Ewald U, Widarsson M. Simulation-based team training improved the self-assessed ability of physicians, nurses and midwives to perform neonatal resuscitation. Acta Paediatr. 2017 Aug;106(8):1273-1279. doi: 10.1111/apa.13861. Epub 2017 May 3. |
| 28085922 | Background | McEwan D, Ruissen GR, Eys MA, Zumbo BD, Beauchamp MR. The Effectiveness of Teamwork Training on Teamwork Behaviors and Team Performance: A Systematic Review and Meta-Analysis of Controlled Interventions. PLoS One. 2017 Jan 13;12(1):e0169604. doi: 10.1371/journal.pone.0169604. eCollection 2017. |
| 11947979 | Background | Finer NN, Rich W. Neonatal resuscitation: toward improved performance. Resuscitation. 2002 Apr;53(1):47-51. doi: 10.1016/s0300-9572(01)00494-4. |
| 26477410 | Background | Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlar A, Wyllie J, Zideman DA; ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015 Oct;95:1-80. doi: 10.1016/j.resuscitation.2015.07.038. Epub 2015 Oct 15. No abstract available. |
| 30027817 | Background | Rosqvist E, Lauritsalo S, Paloneva J. Short 2-H in Situ Trauma Team Simulation Training Effectively Improves Non-Technical Skills of Hospital Trauma Teams. Scand J Surg. 2019 Jun;108(2):117-123. doi: 10.1177/1457496918789006. Epub 2018 Jul 20. |
| 23318204 | Background | Sawyer T, Laubach VA, Hudak J, Yamamura K, Pocrnich A. Improvements in teamwork during neonatal resuscitation after interprofessional TeamSTEPPS training. Neonatal Netw. 2013 Jan-Feb;32(1):26-33. doi: 10.1891/0730-0832.32.1.26. |
| 30095658 | Background | Truta TS, Boeriu CM, Copotoiu SM, Petrisor M, Turucz E, Vatau D, Lazarovici M. Improving nontechnical skills of an interprofessional emergency medical team through a one day crisis resource management training. Medicine (Baltimore). 2018 Aug;97(32):e11828. doi: 10.1097/MD.0000000000011828. |
| 41966605 | Derived | Chen HW, Guo SL, Chen CY, Kang EY, Liu PC, Huang CC, Hu SH, Wu JC, O'Donnell JM. Comparing teaching methods on novice nurses' and medical residents' resuscitation teamwork knowledge and team performance: A longitudinal randomized controlled trial. Nurse Educ Pract. 2026 May;93:104827. doi: 10.1016/j.nepr.2026.104827. Epub 2026 Apr 5. |
| NOT COMPLETED |
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The team of PGY doctors and nurses received training in resuscitation teamwork skills through a simulation-based teaching approach.
| BG002 | Lecture-based Learning | The team of PGY doctors and nurses received training in resuscitation teamwork skills through an interactive lecture-based learning approach. |
| BG003 | Total | Total of all reporting groups |
| years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Working experience (months) | Count of Participants | Participants |
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| Education | Count of Participants | Participants |
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| Units | Count of Participants | Participants |
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| Resuscitation experience (times after work) | Count of Participants | Participants |
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| ACLS/BLS certification | Count of Participants | Participants |
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| ID |
|---|
| Title |
|---|
| Description |
|---|
| OG000 | Board Game-based Learning | The team of PGY doctors and nurses received training in resuscitation teamwork skills through a board game-based teaching approach. |
| OG001 | Simulation-based Learning | The team of PGY doctors and nurses received training in resuscitation teamwork skills through a simulation-based teaching approach. |
| OG002 | Lecture-based Learning | The team of PGY doctors and nurses received training in resuscitation teamwork skills through an interactive lecture-based learning approach. |
|
|
|
| Primary | Knowledge of Teamwork Assessment | The "Knowledge of Teamwork" assessment, aimed at evaluating healthcare professionals' understanding of teamwork knowledge, consists of 23 multiple-choice items based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) Learning Benchmarks provided by the Agency for Healthcare Research and Quality. Each item is formulated as a statement that participants must evaluate as true or false, choosing from five available answer options, of which only one is correct. Participants earn one point for each correct response, with no points awarded for incorrect answers, resulting in a total possible score of 0 to 23. A higher score signifies a more comprehensive understanding of the principles of teamwork knowledge. | The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak. | Posted | Median | Inter-Quartile Range | score on a scale | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
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| Secondary | Interprofessional Collaboration Scale | The attitudes of healthcare professionals toward interprofessional collaboration were assessed using the 'Interprofessional Collaboration Scale' (IPC), which consists of 26 items. The Interprofessional Collaboration Scale covers three main aspects: communication, accommodation, and isolation. We adopted the first 13 items because they are relevant to medical and nursing professional backgrounds. The scale ranges from 1 (strongly disagree) to 4 (strongly agree), with total scores ranging from 13 to 52. A higher score indicates a more positive attitude toward interprofessional collaboration. | The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak. | Posted | Median | Inter-Quartile Range | score on a scale | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
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| Secondary | Resuscitation Knowledge Scale | The healthcare professionals' resuscitation medical knowledge was assessed using the 'Adavance Cardiac Life Support Precourse Self-Assessment,' which consisted of 60 items. The assessment covered three main aspects: rhythm identification, pharmacology, and practical application. We selected 20 items related to resuscitation medical management (ventricular tachycardia, ventricular fibrilation, asystole, pulseless electrical activity). The total score ranged from 0 (minimum) to 20 (maximum), with higher scores indicating a better understanding of resuscitation medical knowledge. | The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak. | Posted | Median | Inter-Quartile Range | score on a scale | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
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| Secondary | Medical Task Performance | The medical team's resuscitation management performance was assessed using the "Medical Task Performance" checklist. The checklist items were referenced from the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Twenty items were identified by an expert panel based on the resuscitation guidelines, including applying adequate oxygen according to the patient's dynamic condition, timely identification of cardiac arrest and provision of high-quality cardiopulmonary resuscitation, identification of shockable rhythms and delivery of timely and correct shocks, and correct administration of resuscitation medication. The checklist was rated on a dichotomous scale with scores of 2 (complete), 1 (partial), and 0 (incomplete). The total score ranged from 0 (minimum) to 40 (maximum), with higher scores indicating better resuscitation management performance by the medical team. | The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak. | Posted | Median | Inter-Quartile Range | score on a scale | Pretest at the 0 week, posttest right after intervention at the 4 weeks, and follow-up test at the 16 weeks. |
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| Secondary | Learning Cognitive Load | The learning cognitive load of healthcare professionals was assessed using the 'Chinese Version of the Learning Cognitive Load Questionnaire,' which consists of 8 items. The questionnaire encompasses two main aspects: mental load and mental effort. The scale ranges from 1 (Strongly Disagree) to 6 (Strongly Agree), with a total score from 6 (minimun) to 48 (maximun). A higher score indicates a higher learning cognitive load. | The total number of participants was 124, with 28 did not complete the pretest, resulting in 96 people completed pretest, intervention and posttest. Subsequently, 48 participants did not complete three-months follow up test , the total number of participants who completed the whole course reduced to 48. For participants who did not complete the study, the reasons included scheduling conflicts, staffing shortages in clinical settings, and surge in COVID-19 outbreak. | Posted | Median | Inter-Quartile Range | score on a scale | The posttest right after intervention at the 4 weeks. |
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| 0 |
| 32 |
| 0 |
| 32 |
| 0 |
| 32 |
| EG001 | Simulation-based Learning | The team of PGY doctors and nurses, including total 32 participants, received 3 hours training intervention in resuscitation teamwork skills through a simulation-based teaching approach. The intervention itself is an educational procedure, which is not including a medical treatment. | 0 | 32 | 0 | 32 | 0 | 32 |
| EG002 | Lecture-based Learning | The team of PGY doctors and nurses, including total 32 participants, received 3 hours training intervention in resuscitation teamwork skills through a interactive lecture-based learning approach. The intervention itself is an educational procedure, which is not including a medical treatment. | 0 | 32 | 0 | 32 | 0 | 32 |
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| D008722 | Methods |
| Posttest |
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| Three months follow-up |
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| 0.05 |
| Median Difference (Final Values) |
| 0.00 |
| 2-Sided |
| Superiority |
| For follow-up test at the 16 weeks. | Kruskal-Wallis | 0.05 | Median Difference (Final Values) | 0.00 | 2-Sided | Superiority |
| Posttest |
|
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| Three months follow-up |
|
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| 0.05 |
| Median Difference (Final Values) |
| 45.00 |
| 2-Sided |
| Superiority |
| For follow-up test at the 16 weeks. | Kruskal-Wallis | 0.05 | Median Difference (Final Values) | 43.00 | 2-Sided | Superiority |
| Posttest |
|
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| Three months follow-up |
|
|
| 0.05 |
| Median Difference (Final Values) |
| 0.00 |
| 2-Sided |
| Superiority |
| For follow-up test at the 16 weeks. | Kruskal-Wallis | 0.05 | Median Difference (Final Values) | 2.50 | 2-Sided | Superiority |
| Posttest |
|
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| Three months follow-up |
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|
| 0.05 |
| Median Difference (Final Values) |
| 0.25 |
| 2-Sided |
| Superiority |
| For follow-up test at the 16 weeks. | Kruskal-Wallis | 0.05 | Median Difference (Final Values) | 0.00 | 2-Sided | Superiority |