O2 A systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals’ situation awareness: implications for training

Background Preventable adverse outcomes related to unrecognised deterioration remain a critical patient safety concern. While numerous factors contribute to these issues, the importance of situation awareness (SA) is increasingly recognised. Fundamentally SA is about knowing what is going on and what might happen next.¹ Endsley’s frequently cited framework² defines SA as ‘the perception of elements in the environment across a volume of time and space, the comprehension of their meaning and the projection of future events.’ Focussed, domain specific SA training is recommended for both novice and experienced healthcare professionals. Methods We undertook a systematic review of the literature to evaluate the effectiveness of educational interventions on healthcare professionals’ SA. In addition we sought to identify guiding theoretical frameworks and the techniques used to evaluate SA outcomes. We systematically searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library from January 2007-March 2017. Eligible articles reported targeted SA interventions or broader interventions incorporating SA and an objectively evaluated SA outcome. Results Thirty nine articles incorporating 19 randomised trial designs were included in the review. Simulation based education (SBE) was the most prevalent educational modality (31 articles). Four articles reported targeted SA interventions, two specified guiding theoretical frameworks and the majority utilised behaviourally anchored rating scales to evaluate SA outcomes. The results suggest that in comparison to other modalities SBE yields better SA outcomes. However, the most effective means of employing SBE is unclear. Conclusions and implications We noted a prevalence of research rationalising the use of SBE and limited theoretically framed interventions. Developing and maintaining SA is a complex process most likely requiring sustained and repetitive educational exposure.² The majority of studies incorporated SA training as part of a broader programme and more than two thirds reported interventions of less than four hours. Generally these programmes target multiple non-technical skills; as such the extent of focus on the key cognitive processes that support SA is unclear. The authors recommend further studies of targeted SA interventions, framed in mastery learning and deliberate practice theories to develop our knowledge of how to optimally use simulation to enhance SA. Reference Singh H, Giardina TD, Petersen LA, et al. Exploring situational awareness in diagnostic errors in primary care. BMJ Quality and Safety 2012;21(1):30–38. doi: 10.1136/bmjqs-2011-000310 Endsley MR. Toward a theory of situation awareness in dynamic systems. Human Factors 1995;37(1):32–64. doi: 10.1518/001872095779049543