Real-time situation awareness assessment in critical illness management: adapting the situation present assessment method to clinical simulation.

Background: Situation awareness (SA) is a human factor of critical importance to patient safety. Simulation training aims to examine and debrief human factors; however, SA cannot be directly observed. This has led to the development of SA measurement tools. The Situation Present Assessment Method (SPAM) measures SA in real-time without the need to pause the scenario. The SPAM process involves the delivery of queries to the participant who must answer them accurately and quickly. The latency between the query being asked and answer being received represents SA.

Method: Two query delivery procedures are described in the literature: query delivery by telephone and in person. These procedures were piloted in simulation teaching with final-year medical students. The scenarios were videotaped and reviewed by the investigators to evaluate each procedure. Our evaluation of the existing SPAM procedures led us to adapt the method by developing a bespoke application, which delivers queries via a personal digital assistant (PDA), calculates the latency data and presents it to the instructor.

Results: Presented by telephone, queries tended to disrupt the 'flow' of the simulation. The 'in person' procedure was not disruptive; however, participants found it difficult to distinguish queries from other dialogue. The PDA represented a compromise between these two techniques: generating data without disrupting the scenario.

Conclusions: The use of SPAM is feasible in clinical simulation. By using handheld technology, SA data are made available to the instructor for use in debrief; this expands the utility of SPAM to the field of medical education.