Comparing the Effectiveness of a Guide Booklet to Simulation-Based Training for Management of Acute Agitation

  • J. Corey WilliamsEmail author
  • Lilanthi Balasuriya
  • Aaron Alexander-Bloch
  • Zheala Qayyum
Original Paper


Simulation-based training may be an effective teaching modality for psychiatry residents; however, simulation-based training is an unstudied and underutilized aspect of psychiatry resident training. The objective of this study was to compare the teaching effectiveness of a simulation-based training to reading a resident on-call psychiatry guide booklet in improving the self-confidence and knowledge of residents that is necessary for managing acutely agitated patients. Pre-intervention self-confidence and knowledge were measured for all residents using a Likert scale questionnaire and a clinical vignette questionnaire, respectively. Residents (n = 23) were randomly assigned to either the simulation group (n = 12) or the guide booklet group (n = 11). Residents in the simulation group completed the simulation-based training, and residents in the guide booklet group were instructed to read the corresponding pages of the booklet regarding management of acute agitation. The comparative teaching effectiveness of the guide booklet and simulation-based training was measured with a post-intervention self-confidence questionnaire and a clinical vignette questionnaire. The study spanned approximately one academic year (July 2016– Sept 2017). Residents who participated in the simulation-based training showed significantly greater improvement in self-confidence (simulation median improvement = 1.458 vs. guide median improvement = 0.033, p = 0.002) and knowledge (simulation median improvement = 0.135 vs. guide median improvement = 0.021, p = 0.0124). Simulation-based training was more effective at improving residents’ self-confidence and knowledge compared to the on-call psychiatry booklet for the management of acutely agitated patients. Though simulation is being used in other specialties, it is a very underutilized tool in the field of psychiatry. This finding underscores the potential for simulation-based training in residency programs to improve resident learning.


Medical education Simulation Residency Behavioral emergency 



The authors wish to thank James Mele, Dan Shabet, Emeric Bojarski, Jennifer Case, Alicia Londono, Yale Simulation Center Staff, and Yale Psychiatric Hospital Staff.

Compliance with Ethical Standards

Disclosure Statement

On behalf of all authors, the corresponding author confirms that there are no conflicts of interest, including financial or personal, that impacted this study.

Ethical Considerations (e.g., IRB information, consent process, if applicable)

The study was designated IRB exempt status by Yale University School of Medicine Institutional Review Board


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Children’s Hospital of PhiladelphiaDepartment of Child & Adolescent Psychiatry and Behavioral SciencesPhiladelphiaUSA
  2. 2.Department of PsychiatryYale-New Haven HospitalNew HavenUSA
  3. 3.School of MedicineHarvard UniversityBostonUSA

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