January 10, 2017

Paper or screen, which is better?

To improve medical management of crisis situations, clinicians should be trained to use cognitive aids – checklists and concise manuals.


For patients in crisis situations, there’s evidence that medical management improves when health care providers use cognitive aids (CAs), that is, checklists and concise manuals.

Which is better, paper or electronic CAs? Scott Watkins, M.D., and colleagues conducted a randomized controlled trial in which 139 anesthesia trainees managed a simulated intraoperative crisis. The study appears in the journal Simulation in Healthcare.

No participants were trained beforehand in the use of CAs. Scoring was based on adherence to practice guidelines. Compared to a control group that was denied CAs during the event, trainees given paper CAs scored 6 percent higher and trainees given electronic CAs scored 7.7 percent higher (only the latter result proved statistically significant). Regardless of format, around one-third of trainees given access to CAs chose not to use them. Use of CAs did not affect time-to-performance overall.

The study “highlights the importance of […] training clinicians in when and how to use an emergency CA,” the authors wrote.

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