Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study

Mejía, Vilma; Gonzalez, Carlos; Delfino, Alejandro E.; Altermatt, Fernando R.; Corvetto, Marcia A.

doi:10.1016/j.bjane.2018.01.009

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Scientific Articles • Rev. Bras. Anestesiol. 68 (3) • May-Jun 2018 • https://doi.org/10.1016/j.bjane.2018.01.009 copy

Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study^☆ ☆ Institution: División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

The primary purpose of this study was to compare the effect of high fidelity simulation versus a computer-based case solving self-study, in skills acquisition about malignant hyperthermia on first year anesthesiology residents.

Methods:

After institutional ethical committee approval, 31 first year anesthesiology residents were enrolled in this prospective randomized single-blinded study. Participants were randomized to either a High Fidelity Simulation Scenario or a computer-based Case Study about malignant hyperthermia. After the intervention, all subjects' performance in was assessed through a high fidelity simulation scenario using a previously validated assessment rubric. Additionally, knowledge tests and a satisfaction survey were applied. Finally, a semi-structured interview was done to assess self-perception of reasoning process and decision-making.

Results:

28 first year residents finished successfully the study. Resident's management skill scores were globally higher in High Fidelity Simulation versus Case Study, however they were significant in 4 of the 8 performance rubric elements: recognize signs and symptoms (p = 0.025), prioritization of initial actions of management (p = 0.003), recognize complications (p = 0.025) and communication (p = 0.025). Average scores from pre- and post-test knowledge questionnaires improved from 74% to 85% in the High Fidelity Simulation group, and decreased from 78% to 75% in the Case Study group (p = 0.032). Regarding the qualitative analysis, there was no difference in factors influencing the student's process of reasoning and decision-making with both teaching strategies.

Conclusion:

Simulation-based training with a malignant hyperthermia high-fidelity scenario was superior to computer-based case study, improving knowledge and skills in malignant hyperthermia crisis management, with a very good satisfaction level in anesthesia residents.

KEYWORDS
Medical education; Patient simulation; Anesthesia; Education; Simulation training; Malignant hyperthermia

	CS, mean (SD)	HFS, mean (SD)	X² test
Age	31.00 (8.18)	30.57 (6.98)	0.085
Years of postgraduate training	5.23 (2.04)	6.50 (8.64)	0.686
Number of HFS sessions previous to this study	4.69 (2.84)	5.57 (2.56)	0.406
Number of HFS MH cases previous to this study	0.08 (0.077)	0.00 (0.00)	0.337
Number of real MH cases previous to this study	0.08 (0.77)	0.07 (0.27)	0.959
Prior academic performance	6.05 (0.24)	6.25 (0.32)	0.084

Performance rubric elements	CS, mean (SD)	HFS, mean (SD)	Mann-Whitney
Recognize differential diagnoses of MH	1.38 (0.58)	1.64 (0.82)	0.685
Recognize signs and symptoms of MH crisis	1.73 (0.44)	2.25 (0.55)	0.025^a a p < 0.05.
Establish and prioritize the initial actions of management	2.54 (0.59)	2.96 (0.13)	0.003^a a p < 0.05.
Ability to dissolve and administer Dantrolene	1.96 (0.75)	2.14 (0.93)	0.685
Recognize MH complications	1.88 (0.71)	2.53 (0.63)	0.025^a a p < 0.05.
Treat the patient under ethical principles	2.35 (0.66)	2.67 (0.42)	0.141
Communication skills with health team	2.2 (0.66)	2.78 (0.47)	0.025^a a p < 0.05.
Communication and interaction with the surgeon	2.92 (0.19)	2.89 (0.28)	1

Satisfaction survey	CS, mean (SD)	HFS, mean (SD)	t-test
The session was funny	4 (0.894)	4.79 (0.426)	0.008^a a p < 0.05.
The session was realistic	4.36 (0.674)	4.57 (0.646)	0.385
The session developed important skills for my future	4.73 (0.467)	4.93 (0.267)	0.182
The time devoted to the session was appropriate	3.91 (0.944)	4.43 (0.756)	0.14
The debriefing/reflection conduction was clear	4.18 (0.751)	4.71 (0.611)	0.045^a a p < 0.05.
The debriefing/reflection session fulfilled the objectives	4.45 (0.522)	4.71 (0.469)	0.143
I feel confident in achieving the objectives of the session	4 (0.632)	4.57 (0.646)	0.03^a a p < 0.05.
Participating in this session was a positive experience	3.2 (0.632)	3.85 (0.376)	0.008^a a p < 0.05.

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:marciacorvetto@gmail.com (M.A. Corvetto).

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Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study☆ ☆ Institution: División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile.

Abstract

Introduction:

Methods:

Results:

Conclusion:

Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study^☆ ☆ Institution: División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile.