title: Repeated simulation-based training for performing general anesthesia for emergency cesarean delivery: long-term retention and recurring mistakes.
abstract: BACKGROUND
  The percentage of women undergoing cesarean delivery under general anesthesia has significantly decreased, which limits training opportunities for its safe administration. The purpose of this study was to evaluate how effective simulation-based training was in the learning and long-term retention of skills to perform general anesthesia for an emergent cesarean delivery.
  
  
  METHODS
  During an eight-week obstetric anesthesia rotation, 24 residents attended lectures and simulation-based training to perform general anesthesia for emergent cesarean delivery. Performance assessments using a validated weighted scaling system were made during the first (pre-test) and fifth weeks (post-test) of training, and eight months later (post-retention test). Resident's competency level (weighted score) and errors were assessed at each testing session. Six obstetric anesthesia attending physicians, unfamiliar with the simulation scenario, generated a mean attendings' performance score. The results were compared.
  
  
  RESULTS
  At one week of training, residents' performance was significantly below mean attendings' performance score (pre-test: 135±22 vs. 159±11, P=0.013). At five weeks, residents' performance was similar to mean attendings' performance score (post-test: 159±21) and remained at that level at eight months (post-retention test: 164±16). Of the important obstetric-specific tasks, left uterine displacement was missed by 46% of residents at eight months.
  
  
  CONCLUSIONS
  Following lectures and simulation-enhanced training, anesthesia residents reached and retained for up to eight months a competency level in a simulator comparable to that of obstetric anesthesia attending physicians. Errors in performance and missed tasks may be used to improve residency training and continuing medical education.
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA. Electronic address: cortner@uw.edu.
authors: C M
authors: CM
authors: Ortner
authors: Department of Anesthesiology, University of Montreal, Quebec, Canada.
authors: P
authors: P
authors: Richebé
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors: L A
authors: LA
authors: Bollag
authors: Director of the Institute for Simulation and Inter-Professional Studies (ISIS), University of Washington, Seattle, WA, USA.
authors: B K
authors: BK
authors: Ross
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors: R
authors: R
authors: Landau
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000776:Anesthesiology / Q000193:education*; D002585:Cesarean Section / Q000193:education*; D002983:Clinical Competence; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000193:education*; D016544:Patient Simulation; D019990:Perioperative Care / Q000193:education; D010820:Physicians; D011247:Pregnancy; D011300:Preoperative Care / Q000193:education
keywords: Cesarean delivery; General anesthesia; Simulation-based training