Does training on an anaesthesia simulator lead to improvement in performance?

Abstract

We have used the Leiden anaesthesia simulator, which makes use of a standard anaesthesia machine and monitors, and realistically simulates the anaesthesia work place. After obtaining informed consent, 28 anaesthetists and anaesthesia trainees in one hospital took part in the study. All participants were exposed to a pre-scripted simulated "control" scenario of anaphylactic shock (phase 1). The sessions were videotaped and the performances of individual participants were evaluated using a standardized scoring scheme. During phase 2, the participants were allocated randomly to undergo training in the management of either anaphylactic shock (group A, n = 13) or malignant hyperthermia (group B, n = 15) on the simulator. After 4 months, each participant underwent a blinded evaluation session with a pre-scripted "test" scenario of malignant hyperthermia (phase 3). These sessions were also videotaped and evaluated as for phase 1. The participants in group B responded more quickly, treated better and deviated less from the accepted procedure during phase 3 than those in group A. The total performance of participants in group B during phase 3 was significantly better than those in group A. We conclude that training on an anaesthesia simulator does improve the performance of anaesthetists in dealing with emergencies during anaesthesia.

Training in airway management

“…Additionally, management of infrequent events such as failed intubation with failed ventilation can be practised without risk to live patients. Although largely unproven, practising these skills within this context is felt to improve technical, cognitive and team-working performance if similar situations are encountered in real life [104]. On this basis, this modality has been incorporated into several airway simulation courses in the UK, providing a hybrid of theory, practical skills stations and participation in airway scenarios in a recreated medical environment (see below).…”

Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session

“…The repetition of simulation sessions may be useful for improving adherence to algorithms in general. 11 However, given the costs of simulation teaching and displacement of experienced physicians from their workplace, there is a definite need for a more reliable and effective way to approach these expert participants.…”

“…In addition, based on a previous study involving simulators, 11 we hypothesized that approximately 50% of the participants would make at least one major deviation from the ASA difficult airway algorithm at baseline (1st CICV). A sample size of 40 would provide 81.6% power to detect a minimum 30% decrease in the proportion of participants committing major deviations from the first to the second session, considering an a error of 0.05.…”

“…1,3,7,8 Simulation has proven value in training management of emergency situations in anesthesia. 11,12 High-fidelity simulation reproduces the conditions under which lifesaving decisions need to be made, adding psychological stress and time pressure, factors known to affect performance. 13 The objective of this prospective controlled single-blinded study was to observe how consultant anesthesiologists currently manage a standard CICV scenario.…”

Review article: Simulation in anesthesia: state of the science and looking forward

“…A number of studies on the effectiveness of simulation-based training have used performance during simulated critical events as outcome measures, in large part due to the challenges of measuring performance in clinical settings. Chopra et al 49 showed that anesthesiologists trained to manage malignant hyperthermia with a full-body mannequin simulator responded more quickly, deviated less from accepted guidelines, and performed better in handling a subsequent simulated malignant hyperthermia than residents who did not receive the training. Yee et al 50 showed that a single simulation session constructed around an ACRM-type course improved non-technical skills (i.e., decision-making, situation awareness, and interpersonal skills) of residents during a simulated anesthesia crisis.…”