Ability Of Trainees Research Articles

ECHOCARDIOGRAPHIC INTERPRETATION SKILLS OF GRADUATING CARDIOLOGY TRAINEES: ARE THEY COMPETENT?

Echocardiography (echo) is an important diagnostic and prognostic tool for managing patients with cardiac disease. Accurate interpretation of echo images is essential to provide high quality patient care. For decades, competence in echo has been conferred by the attainment of a predefined: (1) number of months of training, and (2) number of echo studies performed and interpreted. There is no information regarding the adequacy of a cardiology resident’s echo interpretation skills at the time of cardiology training program completion. The purpose of this study was to assess the proficiency of graduating cardiology trainees at echo interpretation. Sixty-six trainees within 2.5 months of completing a Canadian cardiology training program participated in voluntary testing. The mean number of months of training was 6.3 (range 5-12) months. 65% of trainees had completed the requisite 6 months of echo training to be eligible for Level 2 certification. Trainees were asked to interpret 14 echocardiographic studies that demonstrated important findings in the following categories: left ventricular (LV) size/function, right ventricular (RV) size/function, valvular abnormalities, pericardial disease, hypertrophic cardiomyopathy (HCM), and congenital heart disease. Images were chosen to be representative of those typically encountered in a community cardiology practice. Trainees were asked to: (1) identify any abnormalities, and (2) provide a corresponding interpretation. Evaluation criteria were pre-determined through the consensus of two experienced echocardiographers, who assembled a list of important and critical abnormalities and interpretations for each set of images. Scoring of trainees responses was blinded to identity and performed independently. The average scores for the accurate identification for each category of echo pathology were: LV size/function 45%; RV size/function 85%; valvular abnormalities 57%; pericardial disease 56%, HCM 17%; and congenital heart disease 52%. The average score for the identification of the predefined critical diagnoses was 68%. The average overall score for the cohort was 57.45% (+/−11.8%). 18.2% of trainees achieved the predefined passing grade of 70%. The ability of trainees trained at and graduating from Canadian cardiology training programs to accurately identify and interpret important abnormalities on echo is suboptimal despite having completed the necessary months of echo training required. These findings demonstrate an urgent need to re-evaluate the current approaches to echo training.

Novel Debate-Style Cardiothoracic Surgery Journal Club: Results of a Pilot Curriculum

Traditional journal clubs addressing single articles are limited by the lack of a standardized process for conduct and evaluation. We developed a novel, debate-style journal club for trainees to use best available evidence to address controversial topics in cardiothoracic surgery through discussion of realistic patient scenarios. After implementation of our new curriculum, trainee knowledge acquisition and retention were assessed by a summative test of published literature and standardized debate scoring. Feedback was additionally obtained by trainee and faculty surveys. Cardiothoracic surgery trainees (n= 4) participated in five debates each over 10 monthly sessions. Written examination results after debate revealed a nonsignificant improvement in scores on topics that were debated compared with topics that were not (+9.8% versus-4.2%, p= 0.105). Trainee ability to sway the debate position supported by the attendee strongly correlated with trainee use of supporting literature (r=0.853), moderately correlated with persuasiveness (r= 0.465), and overall effect of the debate (r= 0.625). Surveys completed by trainees and faculty unanimously favored the debate-style journal club as compared to the traditional journal club in gaining familiarity and applying published literature to questions encountered clinically. Our novel debate-style cardiothoracic surgery journal club is an effective educational intervention for cardiothoracic surgery trainees to acquire, retain, and gain practice in applying specialty-specific literature-based evidence to controversial case-based issues. Evaluation by multi-institutional expansion is needed to validate our preliminary findings in this initial trainee cohort.

The design and implementation of phased model in the training of child-EEG physicians

Electroencephalography (EEG) is an important instrument for the evaluation of brain function, and an irreplaceable diagnostic technique for nervous system diseases. At present, China still lacks professional child-EEG talents. Therefore, it is a task of great priority to establish an effective and practical training method and foster more child-EEG physicians. As most trainees have not learned EEG before and only have limited time for learning, we divide the child-EEG training into three phases, includ-ing theory learning, practice training, and EEG reading and interpretation on the basis of the general rules in learning EEG. In the theory learning phase, basic EEG knowledge is taught comprehensively to form a solid foundation for future study. In practice training phase, the trainees acquire important skills of EEG by carrying out complete EEG monitoring, eliminating EEG artifacts, observing seizures, and read real-time EEG. In the phase of EEG reading and interpretation, the trainees learn to analyze EEG gradually by read-ing and report EEG under the guidance of the senior physician. Strict examination is arranged for each phase to evaluate study results objectively. The phased model is designed to implement a step-by-step training of child-EEG and foster the trainee's independent ability to carry out EEG inspection. Key words: Electroencephalography; Children; Physician training; Phased model

Making robust assessments of specialist trainees’ workplace performance

BackgroundWorkplace-based assessments should provide a reliable measure of trainee performance, but have met with mixed success. We proposed that using an entrustability scale, where supervisors scored trainees on the level of supervision required for the case would improve the utility of compulsory mini-clinical evaluation exercise (CEX) assessments in a large anaesthesia training program. MethodsWe analysed mini-CEX scores from all Australian and New Zealand College of Anaesthetists trainees submitted to an online database over a 12-month period. Supervisors’ scores were adjusted for the expected supervision requirement for the case for trainees at different stages of training. We used generalisability theory to determine score reliability. Results7808 assessments were available for analysis. Supervision requirements decreased significantly (P < 0.05) with increased duration and level of training, supporting validity. We found moderate reliability (G > 0.7) with a feasible number of assessments. Adjusting scores against the expected supervision requirement considerably improved reliability, with G > 0.8 achieved with only nine assessments. Three per cent of trainees generated average mini-CEX scores below the expected standard. ConclusionsUsing an entrustment scoring system, where supervisors score trainees on the level of supervision required, mini-CEX scores demonstrated moderate reliability within a feasible number of assessments, and evidence of validity. When scores were adjusted against an expected standard, underperforming trainees could be identified, and reliability much improved. Taken together with other evidence on trainee ability, the mini-CEX is of sufficient reliability for inclusion in high stakes decisions on trainee progression towards independent specialist practice.

A new method to measure efficiency in learning by doing environment: a case study of assembly line simulation

Lean is a set of techniques used to manage a work environment by eliminating waste, organising workplace, streamlining procedures and establishing visual standards. This paper presents a lean laboratory learning experience based on physical parts assembling simulation, which could be used for both students and professionals. Lean laboratory simulation simplifies understanding of practical lean advantages on manufacturing process. The purposes of this paper are to measure the difference between theoretical learning and learning by doing, and also to propose a new lean manufacturing teaching model. Principal results of the presented case study are centred on three pillars, developing training efficiency, evolving trainee's ability to propose real time process improvements and proposing a new training efficiency measurement tool. Further researches could experiment proposed training model with other complicated products in different environment.

Kindness: an innate ability of potential trainees?

Kindness: an innate ability of potential trainees?

Use of Google Glass to Enhance Surgical Education of Neurosurgery Residents: “Proof-of-Concept” Study

The relatively decreased time spent in the operating room and overall reduction in cases performed by neurosurgical trainees as a result of duty-hour restrictions demands that the pedagogical content within each surgical encounter be maximized and crafted toward the specific talents and shortcomings of the individual. It is imperative to future generations that the quality of training adapts to the changing administrative infrastructures and compensates for anything that may compromise the technical abilities of trainees. Neurosurgeons in teaching hospitals continue to experiment with various emerging technologies-such as simulators and virtual presence-to supplement and improve surgical training. The authors participated in the Google Glass Explorer Program in order to assess the applicability of Google Glass as a tool to enhance the operative education of neurosurgical residents. Google Glass is a type of wearable technology in the form of eyeglasses that employs a high-definition camera and allows the user to interact using voice commands. Google Glass was able to effectively capture video segments of various lengths for residents to review in a variety of clinical settings within a large, tertiary care university hospital, as well as during a surgical mission to a developing country. The resolution and quality of the video were adequate to review and use as a teaching tool. While Google Glass harbors the potential to dramatically improve both neurosurgical education and practice in a variety of ways, certain technical drawbacks of the current model limit its effectiveness as a teaching tool.

Failing to Prepare Is Preparing to Fail: A Single-Blinded, Randomized Controlled Trial to Determine the Impact of a Preoperative Instructional Video on the Ability of Residents to Perform Laparoscopic Right Colectomy.

Laparoscopic colorectal resection is an index case for advanced skills training, yet many residents struggle to reach proficiency by graduation. Current methods to reduce the learning curve for residents remain expensive, time consuming, and poorly validated. The purpose of this study was to assess the impact of the addition of a preprocedural instructional video to improve the ability of a general surgery resident to perform laparoscopic right colectomy when compared with standard preparation. This was a single-blinded, randomized control study. Four university-affiliated teaching hospitals were included in the study. General surgery residents in postgraduation years 2 through 5 participated. Residents were randomly assigned to preparation with a narrated instructional video versus standard preparation. Resident performance, scored by a previously validated global assessment scale, was measured. Fifty-four residents were included. Half (n = 27) were randomly assigned to view the training video and half (n = 27) to standard preparation. There were no differences between groups in terms of training level or previous operative experience or in patient demographics (all p > 0.05). Groups were similar in the percentage of the case completed by residents (p = 0.39) and operative time (p = 0.74). Residents in the video group scored significantly higher in total score (mean: 46.8 vs 42.3; p = 0.002), as well as subsections directly measuring laparoscopic skill (vascular control mean: 11.3 vs 9.7, p < 0.001; mobilization mean: 7.6 vs. 7.0, p = 0.03) and overall performance score (mean: 4.0 vs 3.1; p < 0.001). Statistical significance persisted across training levels. There is potential for Hawthorne effect, and the study is underpowered at the individual postgraduate year level. The simple addition of a brief, narrated preprocedural video to general surgery resident case preparation significantly increased trainee ability to successfully perform a laparoscopic right colectomy. In an era of shortened hours and less exposure to cases, incorporating a brief but effective instructional video before surgery may improve the learning curve of trainees and ultimately improve safety.

Evaluation of trainees’ ability to perform obstetrical ultrasound using simulation: challenges and opportunities

Evaluation of trainee's ability in obstetrical ultrasound is a time-consuming process, which requires involving patients as volunteers. With the use of obstetrical ultrasound simulators, virtual reality could help in assessing competency and evaluating trainees in this field. The objective of the study was to test the validity of an obstetrical ultrasound simulator as a tool for evaluating trainees following structured training by comparing scores obtained on obstetrical ultrasound simulator with those obtained on volunteers and by assessing correlations between scores of images and of dexterity given by 2 blinded examiners. Trainees, taking the 2013 French national examination for the practice of obstetrical ultrasound were asked to obtain standardized ultrasound planes both on volunteer pregnant women and on an obstetrical ultrasound simulator. These planes included measurements of biparietal diameter, abdominal circumference, and femur length as well as reference planes for cardiac 4-chamber and outflow tracts, kidneys, stomach/diaphragm, spine, and face. Images were stored and evaluated subsequently by 2 national examiners who scored each picture according to previously established quality criteria. Dexterity was also evaluated and subjectively scored between 0 and 10. The Raghunathan's modification of Pearson, Filon's z, Spearman's rank correlation, and analysis of variance tests were used to assess correlations between the scores by the 2 examiners and scores of dexterity and also to compare the final scores between the 2 different methods. We evaluated 29 trainees. The mean dexterity scores in simulation (6.5 ± 2.0) and real examination (5.9 ± 2.3) were comparable (P = .31). Scores with an obstetrical ultrasound simulator were significantly higher than those obtained on volunteers (P = .027). Nevertheless, there was a good correlation between the scores of the 2 examiners judging on simulation (R = 0.888) and on volunteers (R = 0.873) (P = .81). An obstetrical ultrasound simulator is as good a method as volunteer-based examination for evaluating practical skills in trainees following structured training in obstetrical ultrasound. The threshold for success/failure should, however, be adapted as candidates obtain higher scores on the simulator. Advantages of the obstetrical ultrasound simulator include the absence of location and time constraints without the need to involve volunteers or to interfere with the running of ultrasound clinics. However, an obstetrical ultrasound simulator still lacks the ability to evaluate the trainees' ability to interact with patients.

BEST-TEST2: assessment of hematology trainee knowledge of transfusion medicine.

As transfusion is a common therapy and key component in every hematologist's practice, hematology training programs should dedicate significant time and effort to delivering high-quality transfusion medicine education to their trainees. The current state of hematology trainee knowledge of transfusion medicine is not known. A validated assessment tool developed by the Biomedical Excellence for Safer Transfusion (BEST) Collaborative was used to assess prior transfusion medicine education, attitudes, perceived ability, and transfusion medicine knowledge of hematology trainees. A total of 149 hematology trainees at 17 international sites were assessed. The overall mean exam score was 61.6% (standard deviation, 13.4%; range, 30%-100%) with no correlation in exam scores with postgraduate year or previous transfusion medicine education in medical school or internal medicine residency. However, better scores correlated with 3 or more hours of transfusion medicine education (p = 0.0003) and perceived higher-quality education during hematology training (p = 0.03). Hematology trainees at US sites, where hematology is often combined with oncology training, had statistically lower scores than trainees at non-US sites (56.2% vs. 67.4%; p < 0.0001). In terms of topic areas, although 93% of participants had obtained consent for transfusion, the lowest scores were on transfusion reaction-related questions. Given the overall poor performance, this study serves as an impetus for all hematology training programs to reevaluate the quality and quantity of transfusion medicine training and can assist in the development of targeted curricula.

Study of factors related to the reflection abilities of dental trainees.

This study analysed the internal and external factors related to the reflection abilities of dental trainees. We created transcripts from oral presentations by the dental trainees of Hiroshima University Hospital (n=35, 2012-2013) at a significant event analysis conference. The reflection depths were compared between the trainees of the university hospital and external clinical combination groups. We determined and statistically analysed the reflection depths. At the end of training, a Mann-Whitney U-test revealed a significant difference in the median reflection depths of the groups (U=66, W=342 and P=0.007). The results of multiple regression analysis indicated a significant relation between the reflection depth and external training completion (P=0.024). There were no relations with other factors, including gender and academic background. Experiences in external clinics create a close connection between the staff and trainees because communities of practice can cause deeper reflections. We need to create small groups in large-scale organisations such as university hospitals. This construct can be adapted not only for Japanese dental trainees but also for global dental and other medical trainees.

A model of four hierarchical levels to train Chinese residents’ teaching skills for “practice-based learning and improvement” competency

Objectives: The current study focused on validating a protocol for training and auditing the resident’s practice-based learning and improvement (PBLI) and quality improvement (QI) competencies for primary care. Methods: Twelve second-year (R2), 12 first-year (R1) and 12 postgraduate year-1 residents were enrolled into group A, B and C, respectively, as trainees. After three training protocols had been completed, a writing test, self-assessed questionnaire and mini-OSTE and end-of-rotation assessment were used in auditing the PBLI competency, performance and teaching ability of trainees. Results: Baseline expert-assessed PBLI and QI knowledge application tool writing scores were low for the R1 and R2 residents. After three training protocols, PBLI and QI proficiencies, performance and teaching abilities were improved to similar levels cross the three training levels of residents based on the expert-assessed writing test-audited assessments and on the faculty and standardized clerk-assessed end-of-rotation-/mini-OSTE-audited assessments. Conclusion: The different four-level hierarchical protocols used to teach group A, B and C were equally beneficial and fitted their needs; namely the different levels of the trainees. Specifically, each level was able to augment their PBLI and QI proficiency. This educational intervention helps medical institutions to train residents as PBLI instructors.

Can I Leave the Theatre? A Key to More Reliable Workplace-Based Assessment

Weller, J. M.*†; Misur, M.†; Nicolson, S.†; Morris, J.‡; Ure, S.§; Crossley, J.∥; Jolly, B.¶ Author Information

G523(P) The paediatric return to work programme

Context We developed a half day programme of fully immersive simulation in a purpose built high fidelity centre to address confidence and training needs of paediatric ST doctors returning to clinical work after a break in practice. Problem Returning to work after a break from clinical practice is daunting. Many trainees have up to a year away from clinical work on maternity leave or out of programme experience (OOP). Trainees undertaking research have up to 3 years away. Feeling under-confident, stressed and de-skilled can result in underperformance which ultimately puts patient safety at risk. Assessment of problem and analysis of its causes Research suggests that the length of time away from clinical practice is a key factor affecting a doctor’s performance when returning to practice – the longer the time out of clinical medicine in years the poorer their performance. 67% of doctors absent from practice for more than 18 months require moderate to considerable re-education or training. The RCPCH has written guidence to support trainees returning to work however simulation as a tool facilitating this process does not feature. We conducted a literature review but were unable to find any stand alone UK simulation programmes specifically aimed at helping paediatricians return to clinical practice safely. Intervention A Paediatric Return To Work Simulation Programme was developed and piloted to address trainees confidence, skills and knowledge. We used scenarios mapped to the RCPCH curriculum covering key areas of emergency management, safeguarding, leadership, communication skills and human factors. Study design The effectiveness of our programme was assessed using pre and post programme questionnaires (Table 1). Two questionnaires were undertaken immediately before and after simulation training and a final questionnaire was undertaken 3 months later following their return to clinical practice. Our primary outcome was aimed at evaluating the trainees confidence levels managing neonatal, paediatric and safeguarding problems and whether these improved following our simulation programme. We were also interested in the overall learning experience perceived by the trainees. Strategy for change All OOP trainees within the deanery were emailed information about the pilot programme. 25 trainees participated in the pilot from September 2013–2014. Measurement of improvement 88% of trainees expressed concern about returning to clinical practice prior to the simulation. Reasons given included lack of knowledge, technical skills, confidence, competence and senior responsibility. Likert scales were used to assess confidence in managing acute paediatric, neonatal, and safeguarding problems pre and post intervention. Results -confidence All trainees found the programme beneficial 100% found the training useful preparation for returning to work. 100% agreed the experience learned from the training had been useful in their clinical work. Free text responses were all overwhelmingly positive. Effects of changes This programme improves confidence and the perceived ability of trainees to manage acute clinical problems. This positive effect appears to be sustained. As a result of this pilot “The Paediatric Return to Work Simulation Programme” has secured funding and been approved regionally for trainees to attend prior to their return to clinical work. Lessons learnt Organisations must have clear support and training in place to enable trainees to return to clinical work safely. Paediatric simulation can effectively facilitate this process. Future development would be aimed at identifying whether these positive effects result in an improvement in clinical practice and safety. Message for others Simulation training programmes facilitating safe return to work should be available nationally and within other specialities.

Evaluating training context competence of use: Productive and unproductive models of use

This study discusses an evaluation model carried out in vocational training contexts and draws from a line of studies that have analyzed the processes of meaning construction according to a semiotic and contextual perspective (Freda, 2011; Freda & De Luca Picione, 2014; Salvatore & Freda, 2011; Salvatore & Venuleo, 2008; Valsiner, 2007).The study aims to identify models of use of training contexts (thought of as different ways to give meaning to the relationship between the trainee and the training context), as well as to analyze their relationship with social–demographic variables and course type. An additional aim is to investigate training outcomes to discern any connection existing between models of use and competence of use (e.g. the ability of trainees to participate and benefit from the training setting for their professional development aims).An especially designed ad hoc open-answer questionnaire was administered to 76 trainees in the ex-post impact training phase. We adopted a multi-method analysis methodology (Bolasco, 1999).Data analysis pointed to three models of use: Opaque, Learning, Development. The last one showed a significant association with training outcomes which were effective and useful to hypothesize the development of a competence of use.The results have interesting implications for the design of evaluation programs directed to the sensemaking processes that organize the relationship between the formative self and the training context.

Home virtual reality simulation training: the effect on trainee ability and confidence with laparoscopic surgery

Home virtual reality simulation training: the effect on trainee ability and confidence with laparoscopic surgery

Medical school handoff education improves postgraduate trainee performance and confidence

Objectives: Determine postgraduate first-year (PGY-1) trainees ability to perform patient care handoffs and associated medical school training.Methods: About 173 incoming PGY-1 trainees completed an OSCE handoff station and a survey eliciting their training and confidence in conducting handoffs. Independent t-tests compared OSCE performance of trainees who reported receiving handoff training to those who had not. Analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities, with significance set at p < 0.05.Results: About 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Mean handoff performance score was 69.5%. Trainees who received instruction or feedback during medical school had higher total and component handoff performance scores (p < 0.05); they were also more confident in their handoff abilities (p < 0.001). Trainees with higher self-assessed skills and preparedness performed better on the OSCE (p < 0.05).Conclusions: This study provides evidence that incoming trainees are not well prepared to perform handoffs. However, those who received instruction during medical school perform better and are more confident on standardized performance assessments. Given communication failures lead to uncertainty in patient care and increases in medical errors, medical schools should incorporate handoff training as required instruction.

Can I leave the theatre? A key to more reliable workplace-based assessment

The value of workplace-based assessments such as the mini-clinical evaluation exercise (mini-CEX), and clinicians' confidence and engagement in the process, has been constrained by low reliability and limited capacity to identify underperforming trainees. We proposed that changing the way supervisors make judgements about trainees would improve score reliability and identification of underperformers. Anaesthetists regularly make decisions about the level of trainee independence with a case, based on how closely they need to supervise them. We therefore used this as the basis for a new scoring system. We analysed 338 mini-CEXs where supervisors scored trainees using the conventional system, and also scored trainee independence, based on the need for direct, or more distant, supervision. As supervisory requirements depend on case difficulty, we then compared the actual trainee independence score and the expected trainee independence score obtained externally. Compared with the conventional scoring system used in previous studies, reliability was very substantially improved using a system based on a trainee's level of independence with a case. Reliability improved further when this score was corrected for case difficulty. Furthermore, the new scoring system overcame the previously identified problem of assessor leniency and identified a number of trainees performing below expectations. Supervisors' judgements on trainee independence with a case, based on the need for direct or more distant supervision, can generate reliable scores of trainee ability without the need for an onerous number of assessments, identify trainees performing below expectations, and track trainee progress towards independent specialist practice.

Training in Minimally Invasive Lobectomy: Thoracoscopic Versus Robotic Approaches

Skills required for thoracoscopic and robotic operations likely differ. The needs and abilities of trainees learning these approaches require assessment. Trainees performed initial components of minimally invasive lobectomies using thoracoscopic or robotic approaches. Component difficulty was scored by trainees using the NASA task load index (NASATLX). Performance of each component was graded by trainees and attending surgeons on a 5-point ordinal scale (naïve, beginning learner, advanced learner, competent, master). Eleven surgical trainees performed 87 replications among three lobectomy components (divide pulmonary ligament; dissect level 7/8/9 nodes; dissect level 4/5 nodes). Before performance NASATLX scores did not differ among components or between surgical approaches. Trainees' after performance NASATLX scores appropriately calibrated task load for the components. After performance NASATLX scores were significantly lower for thoracoscopy than before performance estimates; robotic scores were similar before surgery and after performance. Task load was higher for robotic than for thoracoscopic approaches. Trainees rated their performance higher than did attending surgeons in domains of knowledge and thinking, but ratings for other domains were similarly low. Ratings for performance improved significantly as component performance repetitions increased. Trainees did not differentiate task load among components or surgical approaches before attempting them. Task load scores differentiated difficulty among initial components of lobectomy, and were greater for robotic than for thoracoscopic approaches. Trainees overestimated their level of cognitive performance compared with attending physician evaluation of trainee performance. The study provides insights into how to customize training for thoracoscopic and robotic lobectomy and identifies tools to assess training effectiveness.

The Effect of High-Fidelity Simulation on the Confidence and Decision-Making Ability of Anaesthesia Trainees in Managing Subsequent Simulated ‘Can't Intubate, Can't Oxygenate’ scenarios

The decision to attempt a percutaneous airway in a recognised 'Can't Intubate, Can't Oxygenate' (CICO) situation may occur too late to avoid a poor outcome. Our study was designed to investigate the effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing CICO scenarios in subsequent simulation. Nine anaesthesia trainees from Logan Hospital participated. Pre-study questionnaires surveying confidence levels in various anaesthetic crises were completed. All participants underwent an education session based on algorithms developed for failed intubation and ventilation, and techniques for securing percutaneous airway access. However, only four of the nine participated in a high-fidelity simulation session. All nine participants were then filmed during 'mini-simulation' assessment sessions and completed post-study questionnaires identical to those at the commencement of the study. The four trainees who had undertaken the initial high-fidelity simulation had a lower median time to laryngeal mask airway attempt (60 versus 115 seconds) and time to percutaneous airway attempt (111 versus 172 seconds) in the subsequent simulation. The median number of deviations from the Difficult Airway Society algorithm was 0 for the simulation group compared to 1 for the non-simulation group. This small study suggests that high-fidelity simulation shortens the decision-making time of anaesthesia trainees in subsequent simulated CICO scenarios. This observation warrants follow-up in larger prospective trials.