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Performance gaps and improvement plans from a 5-hospital simulation programme for anaesthesiology providers: a retrospective study
  1. Samuel DeMaria Jr1,
  2. Adam Levine1,
  3. Philip Petrou2,
  4. David Feldman3,
  5. Patricia Kischak3,
  6. Amanda Burden4,
  7. Andrew Goldberg1
  1. 1Department of Anesthesiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
  2. 2Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
  3. 3Hospitals Insurance Company, New York, New York, USA
  4. 4Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
  1. Correspondence to Dr Samuel DeMaria Jr, Department of Anesthesiology, Mount Sinai Health System, New York, NY 10029, USA; demarisa{at}


Background Simulation is increasingly employed in healthcare provider education, but usage as a means of identifying system-wide practitioner gaps has been limited. We sought to determine whether practice gaps could be identified, and if meaningful improvement plans could result from a simulation course for anaesthesiology providers.

Methods Over a 2-year cycle, 288 anaesthesiologists and 67 certified registered nurse anaesthetists (CRNAs) participated in a 3.5 hour, malpractice insurer-mandated simulation course, encountering 4 scenarios. 5 anaesthesiology departments within 3 urban academic healthcare systems were represented. A real-time rater scored each individual on 12 critical performance items (CPIs) representing learning objectives for a given scenario. Participants completed a course satisfaction survey, a 1-month postcourse practice improvement plan (PIP) and a 6-month follow-up survey.

Results All recorded course data were retrospectively reviewed. Course satisfaction was generally positive (88–97% positive rating by item). 4231 individual CPIs were recorded (of a possible 4260 rateable), with a majority of participants demonstrating remediable gaps in medical/technical and non-technical skills (97% of groups had at least one instance of a remediable gap in communication/non-technical skills during at least one of the scenarios). 6 months following the course, 91% of respondents reported successfully implementing 1 or more of their PIPs. Improvements in equipment/environmental resources or personal knowledge domains were most often successful, and several individual reports demonstrated a positive impact on actual practice.

Conclusions This professional liability insurer-initiated simulation course for 5 anaesthesiology departments was feasible to deliver and well received. Practice gaps were identified during the course and remediation of gaps, and/or application of new knowledge, skills and resources was reported by participants.

  • simulation

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  • This paper is attributed to the Icahn School of Medicine at Mount Sinai Hospital.

  • Contributors All authors meet the following criteria for authorship equally. SD, AL, PP, DF, PK, AB and AG made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by Hospitals Insurance Corporation (HIC grant number HIC-001).

  • Competing interests None declared.

  • Ethics approval Mount Sinai PPHS.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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