# IMPACTS:  Improving Medical Performance during Acute Crises Through Simulation

> **NIH AHRQ R18** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2020 · $399,018

## Abstract

Understanding and improving clinicians' ability to manage critical events is important
for patient safety. A team of clinician-scientists, simulation educators, and cognitive
scientists propose a five-site in-depth study of the real-time action-oriented decision-
making strategies of anesthesiologists during generalizable high-fidelity critical event
simulations. The Specific Aims are to: 1) Develop and test a unified cognitive model
and taxonomy of the decision-making strategies clinicians use during critical event
management; 2) Create detailed profiles of participants' clinical practice and simulation
experience; 3) Evaluate the factors affecting physicians' critical event performance; and
4) Evaluate the relationship between simulation-based performance assessment and
existing metrics of physician competence (participants' primary board certification
exam scores). We will create four 20-minute realistic simulations of critical events that
are relevant to many acute-care specialties. 120 anesthesiologists at varying career
points will provide detailed demographic, clinical practice, and simulation experience
data. They will wear head-mounted video cameras as they perform in all four scenarios.
Success of each participant's event management will be assessed later from overhead
videos by independent trained experts based on timely completion of pre-defined
`critical performance elements' and global technical and non-technical scores. After each
scenario, cognitive interviews will be conducted using video-cued recall to ascertain
how and why they made their clinical management decisions. We will iteratively code
and analyze all of the interview data to develop a taxonomy of decision strategies; Every
scenario will be coded for the strategies used. We will then analyze how event
performance ratings vary with: participants' actual practice and simulation experience,
the decision strategies used, and written and oral board certification examination
scores. This innovative study will delineate in depth the thought processes of a diverse
sample of physicians in managing critical events. Along with these empirical data, the
project will create a new model and taxonomy for dynamic clinical decision-making,
extending models previously developed for healthcare and other arenas of similar
cognitive demands (e.g. aviation). The study will yield best-practice guidelines on
decision-making in critical event management and information to support policymaking
about the content, execution, and timing of simulation-based training and assessment.

## Key facts

- **NIH application ID:** 9985014
- **Project number:** 5R18HS026158-03
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** MATTHEW BRET WEINGER
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $399,018
- **Award type:** 5
- **Project period:** 2018-08-02 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9985014

## Citation

> US National Institutes of Health, RePORTER application 9985014, IMPACTS:  Improving Medical Performance during Acute Crises Through Simulation (5R18HS026158-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9985014. Licensed CC0.

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