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      Evaluation of resident satisfaction and change in knowledge following use of high-fidelity simulation teaching for anaesthesia residents

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          Abstract

          Background and Aims:

          Anaesthesia practice demands medical knowledge and skills as essential components for patient management in peri-operative emergencies. Since all residents are not exposed to such situations during their residency, training them using simulation technology could bridge this knowledge and skill gap. The aim of this study was to train and evaluate residents to manage anaesthesia emergencies on high fidelity simulators.

          Methods:

          Kirkpatrick model of program evaluation was carried out. Resident reaction was captured using a satisfaction questionnaire and the change in knowledge was assessed using pre-test and post-test Multiple Choice Questions (MCQs). Six scenarios were created and executed on a human patient simulator (HPS). All 22 residents participated in this teaching learning method. The steps of simulation teaching included pre-test, pre-briefing, orientation to manikins, performing/scribe, debriefing, feedback questionnaire, and post-test. The satisfaction questionnaire was administered following the second and fourth scenario.

          Results:

          95% residents agreed on overall satisfaction, that it helps in building team dynamics and clinical reasoning. All students agreed that this teaching had positive professional impact. 14% residents felt they were anxious during the class. The items in the questionnaire had a Cronbach's α value of 0.9. The mean score for pre-test was 24.22 ± 7 (Mean ± SD) and the post-test was 47.18 ± 5.6, the difference between the scores were statistically significant ( P = 0.007).

          Conclusion:

          The use of high-fidelity simulation to train anaesthesia residents resulted in greater satisfaction scores and improved the residents' reasoning skills.

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          Most cited references23

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          Anaesthetists' non-technical skills.

          This review presents the background to the development of the anaesthetists' non-technical skills (ANTS) taxonomy and behaviour rating tool, which is the first non-technical skills framework specifically designed for anaesthetists. We share the experience of the anaesthetists who designed ANTS in relation to applying it in a department of anaesthesia, using it in a simulation centre, and the process of introducing it to the profession on a national basis. We also consider how ANTS is being applied in relation to training and research in other countries and finally, we discuss emerging issues in relation to the introduction of a non-technical skills approach in anaesthesia.
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            Assessment of clinical performance during simulated crises using both technical and behavioral ratings.

            Techniques are needed to assess anesthesiologists' performance when responding to critical events. Patient simulators allow presentation of similar crisis situations to different clinicians. This study evaluated ratings of performance, and the interrater variability of the ratings, made by multiple independent observers viewing videotapes of simulated crises. Raters scored the videotapes of 14 different teams that were managing two scenarios: malignant hyperthermia (MH) and cardiac arrest. Technical performance and crisis management behaviors were rated. Technical ratings could range from 0.0 to 1.0 based on scenario-specific checklists of appropriate actions. Ratings of 12 crisis management behaviors were made using a five-point ordinal scale. Several statistical assessments of interrater variability were applied. Technical ratings were high for most teams in both scenarios (0.78 +/- 0.08 for MH, 0.83 +/- 0.06 for cardiac arrest). Ratings of crisis management behavior varied, with some teams rated as minimally acceptable or poor (28% for MH, 14% for cardiac arrest). The agreement between raters was fair to excellent, depending on the item rated and the statistical test used. Both technical and behavioral performance can be assessed from videotapes of simulations. The behavioral rating system can be improved; one particular difficulty was aggregating a single rating for a behavior that fluctuated over time. These performance assessment tools might be useful for educational research or for tracking a resident's progress. The rating system needs more refinement before it can be used to assess clinical competence for residency graduation or board certification.
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              Teaching residents the two-challenge rule: a simulation-based approach to improve education and patient safety.

              Residents train in a historically hierarchical system. They may be compelled to question their teachers if they do not understand or disagree with a clinical decision, have a patient safety concern, or when treatment plans are unclear. We sought to determine whether a debriefing intervention that emphasizes (1) joint responsibility for safety and (2) the "two-challenge rule" (a rubric for challenging others) using a conversational technique that is assertive and collaborative (advocacy-inquiry) can improve the frequency and effectiveness with which residents "speak up" to superiors. In a simulated operating room, anesthesiology trainees were presented with opportunities to challenge coworkers (eg, orders to administer a relatively contraindicated medication). Opportunities to challenge the attending faculty anesthesiologist, attending faculty surgeon, and nurse (all confederates) were presented. When debriefed, subjects were taught the two-challenge rule and a communication technique that paired advocacy (stating trainee's observation) and inquiry (request for the other's reasoning). A second scenario offered new opportunities to challenge. Video recorded scenarios were evaluated by two investigators and trainee use of the prescribed advocacy-inquiry language was rated on a 5-point scale. Forty subjects participated. Overall use of the two-challenge rule and advocacy-inquiry increased after debriefing. The debriefing and instruction specifically improved the frequency and quality of challenges directed toward superordinate physicians, without improving resident challenges toward nurses. This instructional intervention improves "speaking up" by residents to other physicians during simulated obstetric cases. Providing increased opportunities for resident learning, sharing responsibility for patient safety, and overcoming communication barriers within the medical hierarchy may improve teamwork and patient safety.
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                Author and article information

                Journal
                Indian J Anaesth
                Indian J Anaesth
                IJA
                Indian Journal of Anaesthesia
                Wolters Kluwer - Medknow (India )
                0019-5049
                0976-2817
                November 2019
                08 November 2019
                : 63
                : 11
                : 908-914
                Affiliations
                [1]Department of Anaesthesia, Father Muller Medical College, Mangalore, Karnataka, India
                Author notes
                Address for correspondence: Dr. Shailaja S, Department of Anaesthesia, Father Muller Medical College, Kankanady, Mangalore - 575 002, Karnataka, India. E-mail: drshaila@ 123456fathermuller.in
                Article
                IJA-63-908
                10.4103/ija.IJA_133_19
                6868659
                f2ad58ef-60e7-42f8-b1ca-99887fe0980a
                Copyright: © 2019 Indian Journal of Anaesthesia

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 20 February 2019
                : 26 June 2019
                : 26 August 2019
                Categories
                Original Article

                Anesthesiology & Pain management
                anaesthesia skills,high fidelity simulation,training evaluation

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