• Bevan Yee, Viren N Naik, Hwan S Joo, Georges L Savoldelli, David Y Chung, Patricia L Houston, Bruce J Karatzoglou, and Stanley J Hamstra.
• Patient Simulation Centre, St. Michael's Anesthesia Research into Teaching (SMART) Simulation Group, St. Michael's Hospital, University of Toronto, Ontario, Canada.
• Anesthesiology. 2005 Aug 1;103(2):241-8.

BackgroundCritical incident reporting and observational studies have identified nontechnical skills that are vital to successful anesthesia crisis management. Examples of such skills include task management, team working, situation awareness, and decision making. These skills are not necessarily acquired through clinical experience and may need to be specifically taught. This study uses a high-fidelity patient simulator to assess the effect of repeated exposure to simulated anesthesia crises on the nontechnical skills of anesthesia residents.MethodsAfter institutional research board approval and informed consent, 20 anesthesia residents were recruited. Each resident was randomized to participate as the primary anesthesiologist in the management of three different simulated anesthesia crises using a high-fidelity patient simulator. After each session, videotaped footage was used to facilitate debriefing of their nontechnical skills. The videotapes were later reviewed by two expert blinded independent assessors who rated each resident's nontechnical skills by using a previously validated and reliable marking system.Results: A significant improvement in the nontechnical skills of residents was demonstrated from their first to second session and from their first to third session (both P < 0.005). However from their second to third session, no significant improvement was observed. Interrater reliability between assessors was modest (single rater intraclass correlation = 0.53).ConclusionA single exposure to anesthesia crises using a high-fidelity patient simulator can improve the nontechnical skills of anesthesia residents. However, an additional simulation session may confer little or no additional benefit.

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