RESUMO
BACKGROUND: Healthcare curricula need summative assessments relevant to and representative of clinical situations to best select and train learners. Simulation provides multiple benefits with a growing literature base proving its utility for training in a formative context. Advancing to the next step, "the use of simulation for summative assessment" requires rigorous and evidence-based development because any summative assessment is high stakes for participants, trainers, and programs. The first step of this process is to identify the baseline from which we can start. METHODS: First, using a modified nominal group technique, a task force of 34 panelists defined topics to clarify the why, how, what, when, and who for using simulation-based summative assessment (SBSA). Second, each topic was explored by a group of panelists based on state-of-the-art literature reviews technique with a snowball method to identify further references. Our goal was to identify current knowledge and potential recommendations for future directions. Results were cross-checked among groups and reviewed by an independent expert committee. RESULTS: Seven topics were selected by the task force: "What can be assessed in simulation?", "Assessment tools for SBSA", "Consequences of undergoing the SBSA process", "Scenarios for SBSA", "Debriefing, video, and research for SBSA", "Trainers for SBSA", and "Implementation of SBSA in healthcare". Together, these seven explorations provide an overview of what is known and can be done with relative certainty, and what is unknown and probably needs further investigation. Based on this work, we highlighted the trustworthiness of different summative assessment-related conclusions, the remaining important problems and questions, and their consequences for participants and institutions of how SBSA is conducted. CONCLUSION: Our results identified among the seven topics one area with robust evidence in the literature ("What can be assessed in simulation?"), three areas with evidence that require guidance by expert opinion ("Assessment tools for SBSA", "Scenarios for SBSA", "Implementation of SBSA in healthcare"), and three areas with weak or emerging evidence ("Consequences of undergoing the SBSA process", "Debriefing for SBSA", "Trainers for SBSA"). Using SBSA holds much promise, with increasing demand for this application. Due to the important stakes involved, it must be rigorously conducted and supervised. Guidelines for good practice should be formalized to help with conduct and implementation. We believe this baseline can direct future investigation and the development of guidelines.
RESUMO
BACKGROUND: In outpatient surgery, the patients may be called by phone for detecting and managing perioperative problems. However, phone calls consume time and can waste caregiver's time when the patient is not available. Information and communication technologies could bridge the gap between available resources and need to contact patients. METHODS: In the present before-after study, the before-implementation group was contacted by phone (phone group). The after group was contacted with a SMS or a phone call according to patient's preference (SMS group). The primary outcome was the non-inferiority of the SMS system on the occurrence of preoperative events disturbing the organisation of unit including cancellation of the case related to patient's condition the day before and the day of surgery; non-compliance with fasting rules or requirement of an escort; non-adherence to instructions regarding medication; not reporting to the surgical centre, or a delayed arrival > 30 min. RESULTS: Among 1300 included outpatients (650 per group), 381 (59%) and 542 (83%) patients were successfully contacted in the preoperative period in phone or SMS group, respectively P < 0.0001). Preoperative events were observed in 94 patients of the phone group (14.5% [CI 95% 11.9-17.3]) and in 77 patients of the SMS group (11.8% [CI 95% 9.5-14.6]), meaning that the upper bound 95% CI of the group was within the non-inferiority margin. CONCLUSIONS: In outpatient surgery, implementation of an SMS-based system, supplemented by phone calls for contacting patients is not inferior to a phone-based system in regard to preoperative events.