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A multinational randomised study comparing didactic lectures with case scenario in a severe sepsis medical simulation course
  1. Chih-Huang Li1,2,
  2. Win-Sen Kuan3,
  3. Malcolm Mahadevan3,
  4. Lynda Daniel-Underwood4,
  5. Te-Fa Chiu5,
  6. H Bryant Nguyen4,6,
  7. for the ATLAS Investigators (Asia neTwork to reguLAte Sepsis care)
  1. 1Department of Emergency Medicine, Chang-Gung Memorial Hospital, Keelung Branch, Keelung City, Taiwan
  2. 2Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Taoyuan, Taiwan
  3. 3Department of Emergency Medicine, National University Health System, Singapore, Singapore
  4. 4Department of Emergency Medicine, Loma Linda University, California, USA
  5. 5Department of Emergency Medicine, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
  6. 6Department of Medicine, Pulmonary and Critical Care, Loma Linda University, California, USA
  1. Correspondence to Dr H Bryant Nguyen, Department of Emergency Medicine and Department of Medicine, Pulmonary and Critical Care Loma Linda University11234 Anderson Street Loma Linda, CA 92354, USA; hbnguyen{at}


Background Medical simulation has been used to teach critical illness in a variety of settings. This study examined the effect of didactic lectures compared with simulated case scenario in a medical simulation course on the early management of severe sepsis.

Methods A prospective multicentre randomised study was performed enrolling resident physicians in emergency medicine from four hospitals in Asia. Participants were randomly assigned to a course that included didactic lectures followed by a skills workshop and simulated case scenario (lecture-first) or to a course that included a skills workshop and simulated case scenario followed by didactic lectures (simulation-first). A pre-test was given to the participants at the beginning of the course, post-test 1 was given after the didactic lectures or simulated case scenario depending on the study group assignment, then a final post-test 2 was given at the end of the course. Performance on the simulated case scenario was evaluated with a performance task checklist.

Results 98 participants were enrolled in the study. Post-test 2 scores were significantly higher than pre-test scores in all participants (80.8±12.0% vs 65.4±12.2%, p<0.01). There was no difference in pre-test scores between the two study groups. The lecture-first group had significantly higher post-test 1 scores than the simulation-first group (78.8±10.6% vs 71.6±12.6%, p<0.01). There was no difference in post-test 2 scores between the two groups. The simulated case scenario task performance completion was 90.8% (95% CI 86.6% to 95.0%) in the lecture-first group compared with 83.8% (95% CI 79.5% to 88.1%) in the simulation-first group (p=0.02).

Conclusions A medical simulation course can improve resident physician knowledge in the early management of severe sepsis. Such a course should include a comprehensive curriculum that includes didactic lectures followed by simulation experience.

  • Education
  • intensive care
  • training
  • infectious diseases

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  • Funding This work was supported by Edwards Lifesciences, Asia Pacific, Singapore in the form of administrative support and travel funding for the investigators to perform the study at the participating medical simulation centres. Edwards Lifesciences did not contribute to the design of the study nor the decision to submit this manuscript for publication.

  • Competing interests HBN has received funding from Edwards Lifesciences to develop the medical simulation course given to the participants in the study.

  • Ethics approval Ethics approval was provided by Loma Linda University Institutional Review Board.

  • Provenance and peer review Not commissioned; internally peer reviewed.