title: Learning on a simulator does transfer to clinical practice.
abstract: OBJECTIVE
  Cricoid pressure is recommended during positive pressure ventilation CPR and during anaesthesia when there is a risk of regurgitation. Studies suggest that cricoid pressure is frequently applied incorrectly placing patients at risk of regurgitation. Simulation training has been shown to improve the performance of cricoid pressure on a simulator, but whether simulation training improves the clinical performance of cricoid pressure was unknown. The aim of our study was to determine if simulator training improved the clinical performance of cricoid pressure.
  
  
  METHODS
  101 medical students and nursing staff were recruited and randomised to receive cricoid pressure simulator training with or without force feedback. Subjects then applied cricoid pressure to an anaesthetised patient while standing on a force plate. The main outcome measure was the number of subjects who applied a mean force of 20-30N during their trial.
  
  
  RESULTS
  Significantly more subjects (20/53, 38%) in the feedback group applied force in the appropriate range (20-30N) compared to the control group (9/48, 19%) (p=0.035, chi square test). The feedback group applied significantly higher forces than did the control group (p=0.029, Mann-Whitney U test).
  
  
  CONCLUSIONS
  Simulation training with force feedback significantly improved the performance of cricoid pressure in the clinical setting. Simulation training should be used more frequently to train and maintain resuscitation skills.
authors.affiliation: Department of Anaesthesia & Pain Medicine, Flinders University, Bedford Park, South Australia, Australia. kurtdomuracki@hotmail.com
authors.forename: K J
authors.initials: KJ
authors.lastname: Domuracki
authors.forename: C J
authors.initials: CJ
authors.lastname: Moule
authors.forename: H
authors.initials: H
authors.lastname: Owen
authors.forename: G
authors.initials: G
authors.lastname: Kostandoff
authors.forename: J L
authors.initials: JL
authors.lastname: Plummer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001696:Biomechanical Phenomena; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000193:education*; D003413:Cricoid Cartilage; D004503:Education, Medical, Graduate / Q000379:methods*; D004511:Education, Nursing, Graduate / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007430:Intraoperative Care / Q000379:methods / Q000592:standards; D008348:Manikins; D008875:Middle Aged; D011312:Pressure; D055815:Young Adult