SIMULATION TRAINING EFFICACY FOR COMPETENCE IN PERIOPERATIVE EMERGENCIES AND CRITICAL INCIDENTS MANAGEMENT ACQUISITION BY RESIDENTS-ANESTHESIOLOGIST

Abstract

Background. The simulation method is actively used in healthcare to replace or reinforce real experience with the patient, preventing risks to the life and health of patients.  Aim: to determine the effectiveness of simulation training of interns on the acquisition of competencies in the management of perioperative emergencies (MPN) and critical incidents (CI) during anesthesia in comparison with traditional teaching technologies - lecture. Materials and methods. A prospective randomized controlled trial was conducted at the Department of Surgery, Anesthesiology and IT of PDO Bogomolets NMU in the period from May 2022 to May 2023. Interns were randomized to 2 groups: the control group(C) and the research(R) group in a ratio of 1:1. After providing verbal informed consent, interns of the 2nd year of study in 2022 and 2023 of graduation in the specialty "Anesthesiology and Intensive Care" were assessed for acquired management competencies perioperative emergencies (MPN) and critical incidents (CI): passed MCQ pretest; conducted a self-assessment of their own competencies; passed 1 simulation scenario with an assessment on the SEX scale during the scenario.  Interns of the control group listened to a 2-hour lecture on "Management of MPN and CI during anesthesia".  The interns of the study group were trained at a 2-day simulation training "Management of MPN and CI", during which they worked out about 10 scenarios with structured debriefing and analysis after each scenario. 3 months after the simulation training, the interns of the study group and the control groups passed a post-test on the algorithms for recognizing / treating MPN and CI, repeated self-assessment of competencies and the final simulation scenario with assessment on the CEX scale during the scenario. Results: the study included 60 interns who agreed to participate. Accordingly, 30 interns were included in 2022 (15 each in gr.С and gr.R) and 30 in 2023 (15 each in gr.С and gr.R).  Before the training, the groups of interns (C and R) did not differ in their self-assessment of competencies in PNS management and critical incidents of CI. Also, groups C and R did not differ in competencies in the management of MPN and CI during the preliminary testing and initial simulation scenario. After passing the 2-day simulation training, group D had significantly better results in passing the POST-test (p<0.00001), and a significantly lower number of critical errors during the final simulation scenario (0.19 [0.05-0.78], p=0.03) compared to group K, which listened to a 2-hour lecture.  Simulation training significantly improved pre-procedure planning (p = 0.012), clinical decisions (p = 0.001), clinical thinking (p = 0.03), resource management and work organization (p = 0.00001), professionalism (p = 0.028) and emergency work (p = 0.00001) compared to traditional training - a 2-hour lecture. Conclusion. Simulation training of interns in the specialty "Anesthesiology and Intensive Care" is significantly more effective for acquiring competencies in the management of perioperative emergencies (MPN) and critical incidents (CI) compared to traditional training - lecture.