Simulation-based training improves physicians' performance in patient care in high-stakes clinical setting of cardiac surgery.
BACKGROUND
Simulation-based training is useful in improving physicians' skills. However, no randomized controlled trials have been able to demonstrate the effects of simulation teaching in real-life patient care. This study aimed to determine whether simulation-based training or an interactive seminar resulted in better patient care during weaning from cardiopulmonary bypass (CPB)-a high stakes clinical setting.


METHODS
This study was conducted as a prospective, single-blinded, randomized controlled trial. After institutional research board approval, 20 anesthesiology trainees, postgraduate year 4 or higher, inexperienced in CPB weaning, and 60 patients scheduled for elective coronary artery bypass grafting were recruited. Each trainee received a teaching syllabus for CPB weaning 1 week before attempting to wean a patient from CPB (pretest). One week later, each trainee received a 2-h training session with either high-fidelity simulation-based training or a 2-h interactive seminar. Each trainee then weaned patients from CPB within 2 weeks (posttest) and 5 weeks (retention test) from the intervention. Clinical performance was measured using the validated Anesthesiologists' Nontechnical Skills Global Rating Scale and a checklist of expected clinical actions.


RESULTS
Pretest Global Rating Scale and checklist performances were similar. The simulation group scored significantly higher than the seminar group at both posttest (Global Rating Scale [mean +/- standard error]: 14.3 +/- 0.41 vs. 11.8 +/- 0.41, P < 0.001; checklist: 89.9 +/- 3.0% vs. 75.4 +/- 3.0%, P = 0.003) and retention test (Global Rating Scale: 14.1 +/- 0.41 vs. 11.7 +/- 0.41, P < 0.001; checklist: 93.2 +/- 2.4% vs. 77.0 +/- 2.4%, P < 0.001).


CONCLUSIONS
Skills required to wean a patient from CPB can be acquired through simulation-based training. Compared with traditional interactive seminars, simulation-based training leads to improved performance in patient care by senior trainees in anesthesiology.
Department of Anesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Heinz R
HR
Bruppacher
Syed K
SK
Alam
Vicki R
VR
LeBlanc
David
D
Latter
Viren N
VN
Naik
Georges L
GL
Savoldelli
C David
CD
Mazer
Matt M
MM
Kurrek
Hwan S
HS
Joo
D000776:Anesthesiology / Q000193:education*; D001794:Blood Pressure / Q000502:physiology; D002315:Cardiopulmonary Bypass; D002983:Clinical Competence; D003627:Data Interpretation, Statistical; D003657:Decision Making; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration; D010346:Patient Care Management / Q000379:methods*; D010348:Patient Care Team; D016544:Patient Simulation; D011446:Prospective Studies; D018401:Sample Size; D000078329:Workforce