title: Performance of certified registered nurse anesthetists and anesthesiologists in a simulation-based skills assessment.
abstract: BACKGROUND
  Anesthesiologists and certified registered nurse anesthetists (CRNAs) must acquire the skills to recognize and manage a variety of acute intraoperative emergencies. A simulation-based assessment provides a useful and efficient means to evaluate these skills. In this study, we evaluated and compared the performance of board-certified anesthesiologists and CRNAs managing a set of simulated intraoperative emergencies.
  
  
  METHODS
  We enrolled 26 CRNAs and 35 board-certified anesthesiologists in a prospective, randomized, single-blinded study. These 61 specialists each managed 8 of 12 randomly selected, scripted, intraoperative simulation exercises. Participants were expected to recognize and initiate appropriate therapy for intraoperative events during a 5-min period. Two primary raters scored 488 simulation exercises (61 participants x 8 encounters).
  
  
  RESULTS
  Anesthesiologists achieved a modestly higher mean overall score than CRNAs (66.6% +/- 11.7 [range = 41.7%-86.7%] vs 59.9% +/- 10.2 [range = 38.3%-80.4%] P < 0.01). There were no significant differences in performance between groups on individual encounters. The raters were consistent in their identification of key actions. The reliability of the eight-scenario assessment, with two raters for each scenario, was 0.80.
  
  
  CONCLUSIONS
  Although anesthesiologists, on average, achieved a modestly higher overall score, there was marked and similar variability in both groups. This wide range suggests that certification in either discipline may not yield uniform acumen in management of simulated intraoperative emergencies. In both groups, there were practitioners who failed to diagnose and treat simulated emergencies. If this is reflective of clinical practice, it represents a patient safety concern. Simulation-based assessment provides a tool to determine the ability of practitioners to respond appropriately to clinical emergencies. If all practitioners could effectively manage these critical events, the standard of patient care and ultimately patient safety could be improved.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri, USA. henrichb@anest.wustl.ed
authors.forename: Bernadette M
authors.initials: BM
authors.lastname: Henrichs
authors.forename: Michael S
authors.initials: MS
authors.lastname: Avidan
authors.forename: Dave J
authors.initials: DJ
authors.lastname: Murray
authors.forename: John R
authors.initials: JR
authors.lastname: Boulet
authors.forename: Joe
authors.initials: J
authors.lastname: Kras
authors.forename: Beverley
authors.initials: B
authors.lastname: Krause
authors.forename: Rebecca
authors.initials: R
authors.lastname: Snider
authors.forename: Alex S
authors.initials: AS
authors.lastname: Evers
mesh_terms: D000776:Anesthesiology / Q000592:standards; D002568:Certification; D002983:Clinical Competence / Q000592:standards; D003198:Computer Simulation; D003422:Critical Care; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D009719:Nurse Anesthetists / Q000592:standards; D016544:Patient Simulation; D011446:Prospective Studies; D011787:Quality of Health Care; D015203:Reproducibility of Results; D016037:Single-Blind Method; D013647:Task Performance and Analysis; D000078329:Workforce