title: Acquisition of critical intraoperative event management skills in novice anesthesiology residents by using high-fidelity simulation-based training.
abstract: BACKGROUND
  Early acquisition of critical competencies by novice anesthesiology residents is essential for patient safety, but traditional training methods may be insufficient. The purpose of this study was to determine the effectiveness of high-fidelity simulation training of novice residents in the initial management of critical intraoperative events.
  
  
  METHODS
  Twenty-one novice residents participated in this 6-week study. Three hypoxemia and three hypotension scenarios were developed and corresponding checklists were validated. Residents were tested in all scenarios at baseline (0 weeks) and divided into two groups, using a randomized crossover study design. Group 1 received simulation-based training in hypoxemic events, whereas Group 2 was trained in hypotensive events. After intermediate (3 weeks) testing in all scenarios, the groups switched to receive training in the other critical event. Final testing occurred at 6 weeks. Raters blinded to subject identity, group assignment, and test date scored videotaped performances by using checklists. The primary outcome measure was composite scores for hypoxemia and hypotension scenarios, which were compared within and between groups.
  
  
  RESULTS
  Baseline performance between groups was similar. At the intermediate evaluation, the mean hypoxemia score was higher in Group 1 compared with Group 2 (65.5% vs. 52.4%, 95% CI of difference 6.3-19.9, P < 0.003). Conversely, Group 2 had a higher mean hypotension score (67.4% vs. 45.5%, 95% CI of difference 14.6-29.2, P < 0.003). At Week 6, the scores between groups did not differ.
  
  
  CONCLUSIONS
  Event-specific, simulation-based training resulted in superior performance in scenarios compared with traditional training and simulation-based training in an alternate event.
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. christinepark@northwestern.edu
authors.forename: Christine S
authors.initials: CS
authors.lastname: Park
authors.forename: Lauryn R
authors.initials: LR
authors.lastname: Rochlen
authors.forename: Edward
authors.initials: E
authors.lastname: Yaghmour
authors.forename: Nicole
authors.initials: N
authors.lastname: Higgins
authors.forename: Jeanette R
authors.initials: JR
authors.lastname: Bauchat
authors.forename: Kyle G
authors.initials: KG
authors.lastname: Wojciechowski
authors.forename: John T
authors.initials: JT
authors.lastname: Sullivan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D018592:Cross-Over Studies; D003627:Data Interpretation, Statistical; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007022:Hypotension / Q000628:therapy; D000860:Hypoxia / Q000628:therapy; D007396:Internship and Residency; D007431:Intraoperative Complications / Q000628:therapy*; D007432:Intraoperative Period; D008297:Male; D015588:Observer Variation; D016544:Patient Simulation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012449:Safety; D013647:Task Performance and Analysis; D016896:Treatment Outcome