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Competency level for performing safe general anesthesia for urgent cesarean delivery evaluated with repeated simulation based-training: long term retention and frequent management mistakes
Abstract Number: T 18
Abstract Type: Original Research
The percentage of women undergoing cesarean delivery under general anesthesia (GA) has significantly decreased within the past years, with obvious implications for anesthesia training1. In our institution, residents will perform between 0-3 cesarean deliveries under GA during their training. The goal of this longitudinal trial was to evaluate whether anesthesia residents achieve and retain a competency level considered safe while performing a rapid sequence induction for an urgent cesarean delivery after undergoing focused simulation-based training over an 8-month period. Secondary aim was to identify occurring mistakes in order to improve anesthesia training.
24 consecutive 2nd year anesthesia residents (CA-2) underwent simulation-based training to perform a GA for urgent cesarean delivery during 1st (pre-test) & 5th week (post-test) of their total 8-week Ob-anesthesia rotation. In order to evaluate retention, residents were retested after 8 months (post-retention test). Competency level was measured on a 198.5 points containing weighted scaling system, validated as a reliable simulation scoring instrument2. Residents’ competency level (mean weighted score, ±SD) and occurring errors were assessed at each testing session. Competency level was compared to that of 6 Ob anesthesia attendings, unfamiliar with the simulation scenario (t-test, p<0.05 significant).
Residents’ pre-test scores were lower than attendings’ scores (135±22 vs 159±11, p=0.013), reaching comparable values at 5 weeks (post-test: 159±21) and 8 months (post-retention test: 164±16). At 8 months, residents failed on 12/22 highly weighted tasks and at least 1/7 Ob-anesthesia tasks, such as omitting left uterine displacement, which was missed by 11/24 residents (Table). Several highly weighted tasks were noted to be missed by Ob anesthesia attendings as well.
Following focused theoretical and clinical training and 2 simulation-based sessions, 4 weeks apart, CA-2 residents reached and retained for up to 8 months a competency level comparable to that of the obstetric anesthesia attendings. Several errors and missed tasks were identified that have the potential to improve future residency training and continuous medical education.
1. Anesthesiology 2005;103:645-53
2. Anesthesiology 2006;105:260-6