Is it valid to assess an individual's performance in team training simulation when the supporting team are confederates? A controlled and randomized clinical trial

Background During simulation training, the confederate is a member of the pedagogical team. Its role is to facilitate the interaction between participants and the environment, and is thought to increase realism and immersion. Its influence on participants' performance in full-scale simulation remains however unknown. The purpose of this study was to observe the effect of the presence of confederates on the participants' performance during full-scale simulation of crisis medical situations. Methods This was a prospective, randomized study comparing 2 parallel groups. Participants were emergency medicine residents engaging in a simulation session, with or without confederates. Participants were then evaluated on their Crisis Resource Management performance (CRM). The overall performance score on the Ottawa Global Rating Scale was assessed as primary outcome and the 5 non-technical CRM skills as secondary outcomes. Results A total of 63 simulation sessions, including 63 residents, were included for statistical analysis (n = 32 for Control group and 31 for Confederate group). The mean Overall Performance score was 3.9 +/- 0.8 in the Control group and 4.0 +/- 1.1 in the Confederate group, 95% confidence interval of the difference [-0.6; 0.4], p = 0.60. No significant differences between the two groups were observed on each CRM items (leadership, situational awareness, communication, problem solving, resource utilization) Conclusion In this randomized and controlled study, the presence of confederates during full-scale simulated practice of crisis medical situations does not seem to influence the CRM skills performance of Emergency medicine residents.