1 Alam F, et al. BMJ Open 2018;8:e020940. doi:10.1136/bmjopen-2017-020940 Open Access Does the age of acute care physicians impact their (1) crisis management performance and (2) learning after simulation-based education? A protocol for a multicentre prospective cohort study in Toronto and Ottawa, Canada Fahad Alam, 1 Vicki R LeBlanc, 2,3 Alan Baxter, 4 Jordan Tarshis, 1 Dominique Piquette, 5 Yuqi Gu, 4 Caroline Filipkowska, 6 Ashley Krywenky, 7 Nicole Kester-Greene, 6 Pierre Cardinal, 8 Shelly Au, 1 Sandy Lam, 4 Sylvain Boet, 2,3,4 Perioperative Anesthesia Clinical Trials Group 9 To cite: Alam F, LeBlanc VR, Baxter A, et al. Does the age of acute care physicians impact their (1) crisis management performance and (2) learning after simulation-based education? A protocol for a multicentre prospective cohort study in Toronto and Ottawa, Canada. BMJ Open 2018;8:e020940. doi:10.1136/ bmjopen-2017-020940 ► Prepublication history for this paper is available online. To view these fles, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2017- 020940). Received 4 December 2017 Revised 9 March 2018 Accepted 6 April 2018 For numbered affliations see end of article. Correspondence to Dr Fahad Alam; fahad.alam@sunnybrook.ca Protocol ABSTRACT Introduction The proportion of older acute care physicians (ACPs) has been steadily increasing. Ageing is associated with physiological changes and prospective research investigating how such age-related physiological changes affect clinical performance, including crisis resource management (CRM) skills, is lacking. There is a gap in the literature on whether physician’s age infuences baseline CRM performance and also learning from simulation. We aim to investigate whether ageing is associated with baseline CRM skills of ACPs (emergency, critical care and anaesthesia) using simulated crisis scenarios and to assess whether ageing infuences learning from simulation-based education. Methods and analysis This is a prospective cohort multicentre study recruiting ACPs from the Universities of Toronto and Ottawa, Canada. Each participant will manage an advanced cardiovascular life support crisis- simulated scenario (pretest) and then be debriefed on their CRM skills. They will then manage another simulated crisis scenario (immediate post-test). Three months after, participants will return to manage a third simulated crisis scenario (retention post-test). The relationship between biological age and chronological age will be assessed by measuring the participants CRM skills and their ability to learn from high-fdelity simulation. Ethics and dissemination This protocol was approved by Sunnybrook Health Sciences Centre Research Ethics Board (REB Number 140–2015) and the Ottawa Health Science Network Research Ethics Board (#20150173–01H). The results will be disseminated in a peer-reviewed journal and at scientifc meetings. Trial registration number NCT02683447; Pre-results. INTRODUCTION The proportion of older acute care physi- cians (ACPs) has been steadily increasing. 1 Within Canada, approximately 32%–40% of anaesthesiologists and emergency and critical care physicians are over the age of 55 years. A survey of members of the American Society of Anesthesiologists in 2013 revealed that a greater percentage of members are older (>55 years) in 2013 compared with 2007. 2 The shift in workforce demographics may be explained by several factors such as the recent economic crisis, which has forced some physicians to choose to delay retirement. Furthermore, the reduction in the number of residency positions in the early 1990s led to a smaller proportion of middle-aged ACPs. 3 4 Thus, with an overall shortage of healthcare providers, this has led to a greater proportion of older ACPs delaying retirement in order to meet the demands of the healthcare system. Acute care specialties such as critical care, emergency medicine and anaesthe- siology require providers to excel at both technical and non-technical skills (eg, team- work, communication and leadership) and Strengths and limitations of this study ► Acute care physicians are recruited from various in- stitutions across Ontario from three specialties. ► Participants are immediately debriefed by experts on their crisis resource management performance. ► Simulation environment for each scenario is tailored to the participant’s specialty. ► Ageing physicians likely did not train with manne- quin-based simulation compared with physicians who recently completed their certifcation.