Effect of A Simulation-based Program in Common Anesthesia Events During Orientation in An Anesthesia Training Program.

Abstract

BACKGROUND: First year anesthesia residents (CA-1) enter highly stressful work and learning environments with minimal preparation for new decision-making responsibilities. Simulation-based learning leads to the building of generative skills resulting in enhanced self-efficacy. The aim of the study was to analyze the effect of simulation-based teaching of common clinical intraoperative scenarios on the resident’s self-ratings of confidence. Additionally, we surveyed the trainees for an assessment of the fidelity and usefulness of the program. METHOD: A prospective study was performed with the CA-1 residents during a 21 day period during the first month of training. The residents initially completed a precourse self-confidence survey consisting of 25 questions, scaled 1 to 10 with 1 = no confidence to 10 = fully confident. They received simulation-based instruction in the conduct of anesthesia and management of routine intraoperative problems (hypoxia, hypotension, and hypertension) using SimMan® (Laerdal Medical, Wappingers Falls, NY). The residents received 3 sessions lasting 60 minutes each. Upon completion of the course, the residents completed an identical postcourse confidence survey. At the end of the session, residents completed a survey to assess their perceptions of simulation-based education, the relevance and face validity of the clinical scenarios, and the effectiveness of the sessions (23 questions on a 1 to 5 Likert scale, 1 = strongly disagree to 5 = strongly agree). Both the mean confidence level for each resident as well as the group’s cumulative mean confidence levels were determined. The group data were analyzed by paired Student’s t test. The individual questionnaire data was analyzed by Wilcoxan signed rank test for paired data. Statistical significance was defined as P <0.05. The evaluation surveys were analyzed for frequency distributions and data reported as mean values as well as percentage of respondents who agreed or disagreed with the statements. RESULTS: All 23 trainees completed the course and surveys. The cumulative mean trainee confidence measure (N= 23) increased significantly (P <0.001) from a precourse value of 5.72 + SD 2.24 to a postcourse value of 6.95 + SD 1.94. The mean confidence measures increased in 21 of 23 residents. With respect to the individual survey questions, both the cumulative mean and individual confidence scores increased in 24 of 25 questions after the sessions. The sessions were felt to be sufficiently realistic (4.32 + 0.65 [mean, S.D.]) and the fidelity of the simulations was rated highly by 91% (Likert scores 4) of the residents. The sessions reinforced clinical concepts in the didactic program (4.32 + 0.84) and increased confidence (4.00 + 0.69) to take care of patients in 86% of the trainees (Likert scores 4). All of the residents indicated that simulation-based teaching should be mandatory during the orientation (4.64 + 0.49). CONCLUSIONS: Completion of the simulation-based course led to a significant (P <0.001) improvement in the confidence level of the trainees. The program was well received by the residents, and they expressed a strong desire to continue this type of training throughout their residency.