Critical action procedures testing: a novel method for test-enhanced learning

Abstract

Human error is a leading cause of adverse events in anaesthesia. Residents' knowledge of how to respond to rare, yet potentially life-threatening events has been shown to deteriorate over time and thus cost-effective educational interventions are indicated. Previous research has shown that test-enhanced learning has the potential to strengthen both clinical knowledge and performance. We hypothesised that critical action procedures (CAPs) tests, similar to those employed by high-performance aircraft pilots, would help improve resident knowledge about how to respond to rare and potentially catastrophic events encountered during the perioperative period. Knowledge assessments were administered to 29 first-year anaesthesiology residents over the course of 9 months. Five-minute closed-book tests were administered with fill-in-the-blank questions regarding the American Society of Anesthesiologists' difficult airway guideline, advanced cardiac life support protocols, an institutional airway fire protocol and drug dosing for malignant hyperthermia. Inter-group comparisons were evaluated using the Kruskal-Wallis test. The difference between the pre-test and final test scores for each subsection was determined with the Mann-Whitney U-test for independent samples. Composite subtest scores, when compared with baseline pre-test scores and subsequent scores, and when adjusted for attrition, significantly improved over the course of 9 months (20.5% versus 80%; P < or = 0.001). Likert-based survey data indicated a positive report for attainment of knowledge. In this longitudinal observational study of first-year anaesthesiology residents, CAPs testing helped improve knowledge about critical events. Although the study was limited by its small number of subjects, a significant attrition rate and the lack of a control group, it demonstrates a cost-effective educational intervention that improved resident knowledge. This intervention may enable residents to transfer learned skills from theoretical testing situations to real-life scenarios. We propose the use and further study of CAPs testing as a cost-effective modality to augment both simulated and actual experiential learning.