Board #164 - Research Abstract When the Manikin Dies: Creation and Exploration of a Theoretical Framework Using a Mixed Methods Approach (Submission #7882)

Hypothesis Controversy exists in the simulation community as to the emotional and educational ramifications of unplanned manikin death on learners.1-3 No theoretical framework to guide future investigations of learner actions currently exists. The purpose of our study is to generate and explore a model of learner experience and manikin death as a guide for future research using a mixed methods approach. Methods This study was exempted from review by the University of Louisville IRB. The study consisted of an initial focus group phase composed of learners who had previous experienced an unplanned manikin death as a part of normal educational activities. Scripted questions were posed to each focus group and these conversations were recorded and transcribed. Transcripts were analyzed by three different coders and were triangulated using a grounded theory approach to generate a list of relevant themes.4-5 These were further organized into a framework depicting relationships between them. A survey was generated using this framework as a guide and subsequently distributed to all learners who had experienced an unplanned manikin death. Results were analyzed using a mixed methods approach and used to refine the model. Statistical comparisons were performed using the Pearson Correlation Coefficient and Chi Square tests as applicable. Results Eleven clinicians (two residents, two fellows, and seven nurses) participated in focus groups. Analysis of transcription data revealed seven themes that were organized into a framework representing the learner response to manikin death. The subsequent survey was completed by 41 clinicians (Median experience of three years, range 1 to 42) who had experienced manikin death (median 1 death, range 1 to 20). Key findings included a moderate correlation between the emotional experience of manikin death and degree of pre-session anxiety (Correlation Coefficient 0.46, p<0.001). Debriefing was found to reduce frustration in 27% of respondents (p=0.02), disappointment in 24% (p=0.045), and embarrassment in 29% (p=0.02). Satisfaction increased in 27% (p=0.003). 69% of respondents indicated that manikin death enhanced learning, and 77% of respondents agreed that manikin death positively affected their future practice. These results were used to modify our framework (Figure 1). Figure. No caption available. Conclusion Simulation death appears to be regarded as an important part of realism that does not detract from perceived learning and knowledge retention. A subpopulation of learners likely to carry the emotional effect of manikin death forward into future simulation-based educational activities may exist. Negative emotions that arise because of manikin death can be mitigated by debriefing. We offer the final model as a guide to future research. References 1. Corvetto MA, Taekman JM: To die or not to die? A review of simulated death. Simul Healthc 2013, 8(1):8-12. 2. Fraser K, Huffman J, Ma I, Wright B, McIlwrick J, McLaughlin K: Death of a Manikin: Adverse Effect on Learning and Mechanisms. In.: Chest; 2011. 3. Yardley S: Death is not the Only Harm: Psychological Fidelity in Simulation. Medical education 2011, 45:1061-1063. 4. Patton MQ: Qualitative Research and Evaluation Methods. Thousand Oaks, California: Sage Publications; 2002. 5. Sullivan GM, Sargeant J: Qualities of qualitative research: part I. Journal of graduate medical education, 3(4):449-452. Disclosures Aaron Calhoun receives grant support from the Health Resources and Services Administration.