Study shows age and time in practice inversely impact a physician's crisis resource management skills, but learning through simulation-based education is effective across all ages

Does a physician’s performance change with age?

Existing research on this topic does not provide a definitive answer.

“There were never any prospective trials looking at this question because it is difficult to test without compromising patient safety,” said Fahad Alam, researcher and assistant professor in the Department of Anesthesiology & Pain Medicine.

Executing such a study would be difficult, but Alam, whose research focuses on medical education, felt the solution lay in using simulation-based education to study the crisis resource management skills of acute care physicians across different age groups.

“Ultimately, the goal was not to show that the older you get, the worse you perform. It was to create a study to inform when we should intervene and how well we can educate each other as we age,” added Alam.

Forty-eight acute care physicians from two Canadian universities took part in the study. For months, participants engaged in three simulated eight-minute crisis scenarios, adapted to multiple specialties and designed to be like clinical crises.

After the first scenario, a trained facilitator debriefed participants before they went through another exercise. They returned three to six months later to take part in a final crisis scenario, which studied how many skills they had kept over the period.

Researchers found that physicians, with advancing age and length of time in practice, were more likely to under perform in crisis scenarios unless they had undergone prior simulation training related to their area of clinical practice.

Simulation training was useful in helping physicians stay up to date with current protocols and best practices, no matter their age. However, researchers found that a physician’s ability to recognize when patients were in distress was unchanged, even if they had not had simulation training.

“So, their performance may decline in some areas as they get older, but critically, there is a tool that can help maintain their critical skills and at least bring them back to a baseline,” said Alam.

For researchers, the results revealed that age and years in practice can lead to reduced clinical performance but reaffirmed that simulation-based education is a useful tool for continuous education and training to combat this phenomenon.

Alam hoped the findings will help with the self-reflection of acute care physicians and change how decision-makers view simulation-based education.

“I hope policymakers and healthcare leaders will read the study and start bringing in simulation-based teaching or curriculua at regular intervals to help physicians maintain their skills. I hope that the stigma of learning from simulation is dropped because anyone can learn from this tool at any age,” said Alam.