• Shivesh Prakash, Shailesh Bihari, Russell Laver, Giresh Chandran, Lachlan Kerr, Lambert Schuwirth, and Andrew Bersten.
• College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
• Crit. Care Med. 2020 Sep 1; 48 (9): 1265-1270.

ObjectivesConventionally, simulation-based teaching involves reflection on recalled events (recall-assisted reflection). Instead of recall, video-assisted reflection may reduce recall bias and improve skills retention by contributing to visual memory. Here, we test the hypothesis that when compared with recall, video-assisted reflection results in higher acquisition and retention of skills involved in airway management among junior critical care doctors.DesignRandomized control trial. Participants were randomized 1:1 to video-assisted reflection or recall-assisted reflection group.SettingUniversity-affiliated tertiary care center.SubjectsJunior critical care doctors.InterventionVideo-assisted reflection.Measurements And Main ResultsAll participants underwent simulation-based teaching of technical and nontechnical airway skills involved in managing a critically ill patient. These skills were assessed before, post-workshop, and in the following fourth week, by two independent blinded assessors using a validated scoring tool. Quality of debrief was assessed using a validated questionnaire. Repeated-measures analysis of variance was used to assess time and group interaction. Forty doctors were randomized. At baseline, the groups had similar airway experience (p = 0.34) and skill scores (p = 0.97). There was a significant interaction between study groups and changes over time for total skill scores (F[2, 37] = 4.06; p = 0.02). Although both the study groups had similar and significant improvement in total skills scores at the postworkshop assessment, the decline in total skills scores at delayed assessment (F[1, 38] = 5.64; p = 0.02) was significantly more in the recall-assisted reflection group when compared with the video-assisted reflection group. This resulted in lower mean skill scores in the recall-assisted reflection group when compared with the video-assisted reflection group in the delayed assessment (89.45 [19.32] vs 110.10 [19.54]; p < 0.01). Better retention was predominantly in the nontechnical skills. The perceived quality of debrief was similar between the two groups.ConclusionWhen compared with recall, video-assisted reflection resulted in similar improvement in airway skills, but better retention over time.

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