title: Training nonanesthetist administration of propofol for gastrointestinal endoscopy in scenario-based full-scale hybrid simulation--a pilot study.
abstract: OBJECTIVE
  The use of nonanesthetist-administered propofol (NAAP) in GI endoscopy has long been controversial. In the setting of NAAP, acute situations can develop during endoscopy and thus training before starting with NAAPs is considered crucial. The aim was to evaluate a pilot study on crew resource management (CRM)-based training of teams of endoscopists and endoscopy nurses in NAAP in a full-scale hybrid simulation consisting of a full-scale human patient simulator and an endoscopy simulator. Our hypothesis was that the training would increase the self-efficacy of the participants.
  
  
  METHODS
  Four scenarios were created, each with typical side effects of propofol administration. All scenarios included the need for prompt decision-making and treatment. Colonoscopy, gastroscopy or endoscopic retrograde cholangiopancreatography (ERCP) cases were assigned to the course participants in coherence with their main clinical expertise in order to facilitate situated and contextualized training. Twenty-one participants (ten doctors and eleven nurses) completed a questionnaire on self-efficacy before and after the course. A questionnaire regarding the quality and yield of the course was also completed.
  
  
  RESULTS
  For all participants, the self-efficacy score was 26.0 (24.0-28.0; interquartile range) before training and 30.0 (27.0-30.5) after training (p = 0.0003). The ten doctors had a self-efficacy score before training of 26.5 (25.0-29.5) and 30.0 (29.0-33.0) after (p = 0.0078). The eleven nurses scored 24.0 (22.0-26.0) before and 28.0 (27.0-30.0) after training (p = 0.0098).
  
  
  CONCLUSIONS
  Systematic target focused scenario-based training with hybrid simulation of NAAP in endoscopy resulted in increased self-efficacy in both nurses and physicians.
authors.affiliation: Department of Anesthesia and Intensive Care, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Westfelt
authors.forename: Leif
authors.initials: L
authors.lastname: Hedman
authors.forename: Mikael
authors.initials: M
authors.lastname: Axelsson Lindkvist
authors.forename: Lars
authors.initials: L
authors.lastname: Enochsson
authors.forename: Li
authors.initials: L
authors.lastname: Felländer-Tsai
authors.forename: Peter Thelin
authors.initials: PT
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D004506:Education, Nursing; D016099:Endoscopy, Gastrointestinal / Q000193:education*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008348:Manikins; D010865:Pilot Projects; D018794:Problem-Based Learning; D015742:Propofol / Q000008:administration & dosage*; D020377:Self Efficacy
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol