Simulation-based Assessment of Pediatric Anesthesia Skills

Abstract

Background: Assessment of pediatric anesthesia trainees is complicated by the random nature of adverse patient events and the vagaries of clinical exposure. However, assessment is critical to improve patient safety. In previous studies, a multiple scenario assessment provided reliable and valid measures of the abilities of anesthesia residents. The purpose of this study was to develop a set of relevant simulated pediatric perioperative scenarios and to determine their effectiveness in the assessment of anesthesia residents and pediatric anesthesia fellows. Methods: Ten simulation scenarios were designed to reflect situations encountered in perioperative pediatric anesthesia care. Anesthesiology residents and fellows consented to participate and were debriefed after each scenario. Two pediatric

Simulation-based Assessment to Identify Critical Gaps in Safe Anesthesia Resident Performance

“…The generalizability coefficient of 0.81 meets or exceeds that reported in comparable simulation-based assessment studies and high-stakes certification examinations (range, 0.56 to 0.80). 5,[30][31][32][33][34][35] Similar to previous investigations, 5,30,35 our results indicate that additional measurement precision could best be achieved by increasing the number of scenarios, and not the number of raters per scenario. The system design, based on multiple inputs regarding behaviors that are critical to safe performance, combined with the iterative development of detailed and anchored scoring rubrics, attention to scenario standardization, and methodical rater training, was effective in minimizing measurement errors.…”

“…Previous simulation-based anesthesia studies also have documented widespread variability in performance both within and across practitioners with different levels of experience. 5,30,33,36,37 Others have demonstrated that learning curves differ among individuals, and that experience alone does not reliably lead to expertise without accompanying motivation, excellent teaching and feedback associated with practice, and focused environmental resources. [38][39][40][41] Although individual performance may be influenced by many factors, including motivation and realism of the simulated environment, large differences in performance within both resident and fellow groups, especially among individuals in the same or similar training programs, suggest the need for improved educational programs.…”

The Managing Emergencies in Paediatric Anaesthesia global rating scale is a reliable tool for simulation‐based assessment in pediatric anesthesia crisis management

“…If we were to define acceptable reliability as at least 'substantial' level of agreement (i.e., ICC > 0.6), the predictive statistics show us that two raters would be required for each scenario (with some significant attention required to the procedures for the retained throat pack scenario, which would otherwise require three raters). Fehr et al (20) recently published their report of 35 anesthesia trainees participating in ten pediatric anesthesia simulation scenarios at a single institution. Six local faculty designed checklists for each of the ten scenarios.…”

Pulse Physiology Engine: an Open-Source Software Platform for Computational Modeling of Human Medical Simulation

“…These element states cannot be directly determined, but must be assumed and iteratively solved until a valid combination that meets all criteria is found. The matrix form of the solution can be further defined by (11).…”

“…This is particularly true for emergency, military trauma, and critical care medicine. Simulation has been widely adapted in many areas of medicine, including anesthesia and trauma care and been shown to be highly effective in improving clinical confidence and skills [2][3][4][5][6][7][8][9][10][11]. Current training techniques include traditional didactic materials, virtual training scenarios, manikin simulations with and without physiology, and live patient simulations.…”