Use of high-fidelity simulation in obstetric anesthesia to enhance educational experience of the residents
Abstract Number: 4
Abstract Type: Original Research
Introduction: High-fidelity simulation programs involving realistic mannequins may be an invaluable educational tool for training anesthesia residents (1). The current anesthesia residency training program involves didactic teaching and hands-on experience while managing regional anesthesia in obstetric units, however, they get limited exposure to providing general anesthesia in the high-risk obstetric population. The purpose of this study was to assess the ability of the residents to implement the knowledge gained from didactic teaching in the management of general anesthesia for emergency cesarean section in a simulation-based environment.
Methods: After REB approval, we recruited 21 anesthesia residents, who had completed at least 3 months of rotation in obstetric anesthesia, in their 2nd or 3rd postgraduate year at the University of Toronto teaching hospitals. All participants were given a 90-min lecture in the management of general anesthesia for emergency cesarean section which was followed by assessment in a high-fidelity simulation scenario and a debriefing session. The participants were assessed using a checklist for technical skills, developed and validated with the help of ten independent experts in the field of obstetrics anesthesia. They were also assessed for non-technical skills by three independent examiners using a previously validated global rating scale (2).
Results: The participants achieved an overall score of 75.6% for technical skills compared to 68.5% for non-technical skills (Fig 1). We found a trend towards correlation between the technical and non-technical skills (Spearman Rank correlation coefficient=0.38, p-value=0.089). More than 40% of participants did not perform following tasks: obtaining history of past anaesthetic, alerting staff prior to induction of anesthesia, airway assessment, confirmation of the availability of difficult airway cart and suction, administration of aspiration prophylaxis, confirmation of wedging and use of narcotics after delivery.
Conclusion: Our study shows that there are gaps between didactic teaching and practical experience, and many critical procedures could be missed by the residents while managing such cases. Repeated training in simulation sessions may prepare residents to deal with similar cases in their day to day practice more effectively with minimum errors.
References:1 Anesthesiology 1988;69:387-94
2 BJA 2003; 90:580-8.