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Do we need a confederate in full-scale medical simulation? A randomized controlled 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 explore the effect of the presence of a confederate 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 improve the CRM skills performance of Emergency medicine residents. Trial registration: this study does not need to be registered on Clintrial as it doesn’t report a health care intervention on human participants.