[Simulation-based anaesthesia crisis resource management training. Results of a survey on learning success].
BACKGROUND
Up to as many as 38,000 people die in German hospitals each year as a result of preventable medical errors. Anesthetic procedures are generally safer than internal medical procedures and the mortality associated with anesthesia is estimated to be 3.3-5 cases per million. However, this is still 10 times higher than the risk associated with civilian aviation for example. Up to 80% of mistakes are attributable to inadequate execution of non-technical skills (NTS) such as communication, teamwork and organization of the working environment. Training in non-technical skills through Anesthesia Crisis Resource Management (ACRM) is an integral part of the Berlin Simulation Training (BeST) curriculum. The aim of this study was to describe the subjective evaluation of change in routine clinical behavior as a result of simulator training using latent outcome variables such as "subjective evaluation of learning outcome", with special emphasis on communication.


METHODS
In total 235 doctors with varying levels of professional experience received BeST training between 2001 and 2004. An anonymous postal questionnaire was sent to 228 of these participants and the response rate was 64% The questionnaire contained 13 questions covering evaluation of the workshop and learning outcome with respect to communication in the operating room (OR), teamwork in the OR and medical knowledge. Following factor analysis 3 latent outcome variables (subjective evaluation of the learning outcome, workshop-related change in perception of the value of communication and general value and relevance) were generated. Logistic regression was used to determine whether there was any relationship between the latent outcome variables and a number of independent factors.


RESULTS
It was not possible to demonstrate any relationship between the level of professional training, age or date of the workshop and the variables selected to describe subjective evaluation of behavioral change as a result of the workshop. How realistic the candidates perceived the training scenarios to be (p<0.01) and the sex of the candidates (p=0.03) were both significantly related to evaluation and female candidates were more likely to positively evaluate the simulator training. From the candidates' perspective the training significantly altered their perception of the value of NTSs, and in particular communication, during the management of critical incidents in the OR.


CONCLUSIONS
Well-staged and realistic simulation is associated with better learning outcomes. It may be important to take gender aspects into account in ACRM training.
Schröder
T
T
Kliniken für Anästhesiologie und operative Intensivmedizin, Charité - Universitätsmedizin, Campus Virchow Klinikum und Campus Charité Mitte, Charitéplatz 1, 10117, Berlin.
von Heymann
C H
CH
Ortwein
H
H
Rau
J
J
Wernecke
K D
KD
Spies
C
C
D000328:Adult; D000758:Anesthesia / Q000009:adverse effects*; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003142:Communication; D003479:Curriculum; D003625:Data Collection; D004502:Education, Medical, Continuing; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D009873:Operating Rooms / Q000458:organization & administration; D010348:Patient Care Team; D016544:Patient Simulation; D012737:Sex Factors