Survey of change in practice following simulation-based training in crisis management.

INTRODUCTION

Anaesthesiologists face rapidly evolving clinical scenarios. The best learning opportunity is to establish those critical environments. Simulation is an established teaching modality in healthcare.[12] We conducted a survey among the participants of a simulation-based learning (SBL) workshop, to evaluate their attitude, change in knowledge and effects of the training on their practice.

METHODS

A half-day workshop was conducted with a Simman™ simulator, simulating crisis scenarios in anaesthesia. The scenarios simulated were anaphylaxis, advanced trauma life support, cardiac arrest after subarachnoid block and tight bag. No rotation of participants was done. Survey was conducted over a period of 1 month. The questionnaire was designed based on the Kirkpatrick model. The questionnaire had three parts. The first part required the participants to respond based on a Likert scale. The second part evaluated the key learning points. The third part had questions to look for areas for improvement, to assess the attitude towards making SBL mandatory in postgraduate training and results of the training on routine practise. The questionnaire was internally validated by three senior anaesthesiologists experienced in simulation. No external validation was done. After obtaining the Institutional ethics committee approval, the questionnaire was mailed to the participants 3 months after the workshop was conducted. Response to the questionnaire was considered as willingness to participate in the survey. Those not returning the questionnaire were given a reminder call after 2 weeks and those not replying 2 weeks of the call were considered non-responders. The responses obtained were analysed to assess the attitude of the participants toward the simulation-based training programme and also to evaluate the change in knowledge of the trainees and its effect on their clinical practice. Categorical variables are displayed as numbers and percentage.

RESULTS

The workshop was attended by 58 doctors of which 41 responded to the mailed questionnaire, amounting to a response rate of 70.7%. Of the participants six were practitioners and the rest were postgraduate students. The mean age of the participants was 33.2 ± 10.32 years.

Our findings echoed the perceptions of the residents and the practitioners. Major proportion (95%) of the responders agreed that simulation is a useful learning strategy [Table 1]. The participants were also asked about the key learning points which they felt made significant impact on their clinical practice. Thirty-seven (90.2%) reported that communication to the team members in a crisis was a major learning point [Table 2].

Table 1

Feedback on the workshop

Table 2

Key learning points

When asked about the areas for improvement, the majority (82.9%) proposed more chances at hands on training. Seventeen (41.5%) of them felt the need for more mannequins and better equipped simulation labs. Only 27 (65.9%) responders were in favour of having exclusively trained faculty for simulation in routine postgraduate training.

There was unanimous (100%) agreement on making SBL mandatory to postgraduate training. Thirty-eight (92.6%) trainees expressed interest in attending similar workshops in the future. Twenty-nine (70.7%) clinicians witnessed a critical event in their practice after they attended the workshop, of which twenty five (86.2%) perceived a boost in their confidence in clinical management while the rest were not sure about it.

DISCUSSION

The results of our survey show the positive attitude of the participants toward the simulation-based training. It also highlighted the boost in the confidence of the clinicians in the management of crisis situations in their clinical practice. Other studies have also shown encouraging feedback from participants of SBL programmes, all of which supported the concept of introducing simulation into anaesthesia resident training.[345]

Definition of simulation is composed of three components: a device to simulate a patient, used for training of technical and non-technical skills, while giving active feedback to the trainee.[6] We need to modify our methods and curriculum of professional training, so as to move on to newer modalities of teaching which will lead to a decline in the errors in medical practice. All over the world efforts are being made to incorporate simulation into anaesthesia postgraduate training.

Human factors impact our efficiency and management which is a significant factor contributing to the medical errors.[7] Non-technical skills are as important as technical skills in successful clinical management. Our survey results also show the positive impact of the SBL on their non-technical skills like communication with the team members, prioritising and delegating tasks and post crisis re-evaluation. Simulation can have immense applications in the assessment of the clinical performance of the residents.[89]

Majority of our respondents found the debriefing to be constructive and helpful in assessing their performance. Debriefing has been found to be the most effective and important component of the simulation-based learning programmes.[10]

Repeated practising of skills is required to maintain competency, as retention of skills declines over time. Half-day simulation-based learning programmes are not adequate, which points in the direction of the need for periodic re-training. The cost of setting up and maintaining a simulation lab is a major obstacle in the course of making simulation mandatory to postgraduate training. Reviews have showed that high-fidelity simulators do not necessarily give better results. Even low-fidelity simulators with features tailored to the objectives of training coupled with well-trained faculty can give good performance.

The small sample size is a limitation of our study. The response rate was only 70.7%. The increase in confidence and improvement in performance was self-perceived rather than assessed by a formal trainer.

CONCLUSION

Simulation has established itself as a useful educational intervention. Anaesthesia has always been at the forefront in introducing simulation into training of healthcare professionals. We must take steps to make simulation a mandatory component of curriculum for postgraduate training in anaesthesiology in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.