Resident Performance Assessment Measured by Task Completion during an Obstetric Anesthetic Scenario on a High Fidelity Human Patient Simulator

Abstract

Introduction: The ACGME has mandated that residency programs assess competency by developing tools that evaluate proficiency in specific areas. Although anesthesiologists must learn how to respond in emergencies, this competency is difficult to evaluate. Real emergencies are unusual and do not lend themselves to rigorous evaluation. The percentage of patients having Cesarean delivery under general anesthesia (GA) has decreased. In an effort to assess competency we have developed a scenario and a scoring system using a modified Delphi technique on a high fidelity human patient simulator of an emergency Cesarean delivery under GA. The purpose of this study was to compare the task completion rate between residents in their 1st and 3rd year of clinical anesthesia training. Methods: A list of tasks relevant to performing an emergency cesarean delivery under GA was determined by a panel of 6 obstetric anesthesiologists with widespread US geographical representation and practice settings (1). The tasks were divided into four primary components parts: preoperative assessment, anesthesia setup and preparation, induction and intubation, and operative management. Sixteen resident anesthesiologists of different levels of training (8 CA-3 residents with extensive obstetric anesthesia experience, and 8 CA-1 residents with little or no such experience) were videotaped performing the simulation. Four attending anesthesiologists viewed and scored each of the 16 videotapes. To achieve task completion two of the four reviewers had to document performance. Overall task completion rate as well as the completion rate for each of the four component domains was compared between resident training levels using a χ2 statistic. A P < 0.05 was required to reject the null hypothesis. Results: The total number of observed tasks as well as those observed in each component of the simulation is shown in the table. CA-1 residents completed an average of 69 ± 6 percent of the 47 tasks compared to 79 ± 7 percent by the CA-3 residents. Individual tasks that demonstrated the greatest discrepancy between groups were airway evaluation (1/8 of the CA-1 group compared to 6/8 of the CA-3 group) and failure to reduce the inhalation anesthetic concentration following delivery (0/8 of the CA-1 group versus 8/8 of the CA-3 group).TableDiscussion: This study demonstrates that residency performance of an emergency cesarean delivery can be assessed by examination of task completion rates. In addition, identifying areas of greatest discrepancies can be used to structure education in performing critically important tasks for during emergency situations. Conflict of Interest: Authors indicated they have nothing to disclose.