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Impact of repeated simulation on learning curve characteristics of residents exposed to rare life threatening situations
  1. Sree Kumar E J1,
  2. Makani Purva2,
  3. Sarat Chander M1,
  4. Aruna Parameswari3
  1. 1Anaesthesiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
  2. 2Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK
  3. 3Anaesthesiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Sree Kumar E J, Anaesthesiology, Sri Ramachandra Medical College and Research Institute, Chennai, TN 600116, India; sreekumardr{at}gmail.com

Abstract

Background Little is known about the learning curve characteristics of residents undertaking simulation-based education. It is important to understand the time for acquisition and decay of knowledge and skills needed to manage rare and difficult clinical situations.

Method Ten anaesthesiology residents underwent simulation-based education to manage a cannot intubate cannot ventilate scenario during general anaesthesia for caesarean section. Their performance was measured using an assessment tool and debriefed by two experienced anaesthesiologists. The parameters against which the performance was judged were grouped into preoperative assessment, preoperative patient care, equipment availability, induction sequence, communication and adherence to airway algorithm protocol. The scenario was repeated at 6 and 12 months thereafter. The residents’ acquisition of knowledge, technical and non-technical skills were assessed and compared at baseline, 6 months and end of 12 months.

Result The skills of preoperative assessment, preoperative care and communication quickly improved but the specific skill of managing a difficult airway as measured by adherence to an airway algorithm required more than 6 months (CI at 6 vs 12 months: −3.4 to –0.81, p=0.016). The skills of preoperative assessment and preoperative care improved to a higher level quickly and were retained at this improved level. Communication (CI at 0 vs 6 months: −3.78 to −0.22, p=0.045 and at 6 vs 12 months : −3.39 to −1.49, p=0.007) and difficult airway management skill were slower to improve but continued to do so over the 12 months. The compliance to machine check was more gradual and showed an improvement at 12 months.

Conclusion Our study is unique in analysing the learning curve characteristics of different components of a failed obstetric airway management skill. Repeated simulations over a longer period of time help in better reinforcement, retention of knowledge, recapitulation and implementation of technical and non-technical skills.

  • patient simulation
  • communication skills
  • postgraduate medical education
  • airway
  • anesthesia
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Footnotes

  • Contributors The following are the contributions by the authors to this article. SKEJ: design of the work, acquisition, analysis or interpretation of data, drafting, revision, final approval and accountable for all aspects of the work. MP: design of the work; acquisition, analysis, drafting, revision, final approval and accountable for all aspects of the work. SCM: design of the work; acquisition, drafting, revision, final approval and accountable for all aspects of the work. AP: design of the work; drafting, revision, final approval and accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research, Chennai.

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

  • Data availability statement Data are available upon reasonable request.

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