title: Nontechnical skills assessment after simulation-based continuing medical education.
abstract: BACKGROUND
  Human factors have been identified as root causes of human error in medicine. The "Anesthetists' Non-Technical Skills (ANTS) system" evaluates the effect of simulation training and debriefing on nontechnical skills (NTS). Studies suggest that residents' NTS may improve after simulation training but the effect on NTS of practicing anesthesiologists is unclear. The purpose of this study was to determine whether high-fidelity simulation training and debriefing improved the NTS of practicing anesthesiologists using the ANTS tool.
  
  
  METHODS
  In a previous study, 67 practicing anesthesiologists managed a 45-minute standardized anesthetic case using high-fidelity simulation and returned 5 to 9 months later to manage a second case. After Research Ethics Board approval, two blinded video reviewers, trained in the use of the ANTS system, evaluated archived videotapes of the 59 subjects who completed both sessions. Results were analyzed with a mixed-design analysis of variance. Interrater reliability was calculated using the intraclass correlation coefficient.
  
  
  RESULTS
  Interrater reliability for the ANTS scoring was 0.436, P < 0.05. Overall, ANTS scores improved approximately 5% from session 1 to 2 (P < 0.01), but there was no effect due to debriefing. The situational awareness ANTS category showed a statistically significant effect of debriefing (P < 0.05).
  
  
  CONCLUSIONS
  The relatively short simulation intervention, the length of time until the posttest was completed, well-developed NTS in practicing physicians, and a tool that might not be the optimal method of measurement may all account for the lack of improvement in NTS of practicing anesthesiologists as demonstrated in this study.
authors.affiliation: Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada. pam.morgan@utoronto.ca
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Morgan
authors.forename: Matt M
authors.initials: MM
authors.lastname: Kurrek
authors.forename: Susan
authors.initials: S
authors.lastname: Bertram
authors.forename: Vicki
authors.initials: V
authors.lastname: LeBlanc
authors.forename: Teresa
authors.initials: T
authors.lastname: Przybyszewski
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D003299:Cooperative Behavior; D003657:Decision Making; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010348:Patient Care Team; D014743:Videotape Recording