The influence of the simulation environment on teamwork and cognitive load in novice trauma professionals: A pilot-controlled study

Simulation enhances teamwork during trauma resuscitation in novice emergency department professionals. However, little is known about the impact of the environment where simulations occur on their learning process and cognitive load. This pilot study aimed to (1) assess the feasibility of a randomized controlled trial (RCT) to compare the effect of two simulation environments—in situ (or real-life resuscitation room) and in laboratory—and (2) compute effect sizes for teamwork and cognitive load during these activities. Novice nurses, residents, and respiratory therapists (n = 24) were assigned to in situ or laboratory simulations. They participated in two trauma scenarios separated by a debriefing focusing on teamwork. After each simulation, they completed validated questionnaires on teamwork, cognitive load (intrinsic and extraneous), and perceived learning. A mixed ANOVA was used for the analyses. Regarding feasibility, randomization was not possible mainly due to conflicts in participants' schedules. Still, the implementation of the simulations in both environments was a success. The effect of time showed a large effect on teamwork and intrinsic cognitive load, while the effect of groups showed a large effect on perceived learning only. In conclusion, these results demystify the barriers in implementing a RCT and could be used to guide a larger study.