Pediatric Anesthesia

Simulation-based Assessment of Pediatric Anesthesia Skills

Fehr JJ, Boulet JR, Waldrop WB, et al (Washington Univ School of Medicine, St Louis, MO; Foundation for Advancement of International Med Education and Res, Philadelphia, PA) Anesthesiology 115:1308-1315, 2011^§

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 anesthesiologists scored each scenario by key action checklist. The psychometric properties (reliability, validity) of the scores were studied.

Results

Thirty-five anesthesiology residents and pediatric anesthesia fellows participated. The participants with greater experience administering pediatric anesthetics generally outperformed those with less experience. Score variance attributable to raters was low, yielding a high interrater reliability.

Conclusions

A multiple-scenario, simulation-based assessment of pediatric perioperative care was designed and administered to residents and fellows. The scores obtained from the assessment indicated the content was relevant and that raters could reliably score the scenarios. Participants with more training achieved higher scores, but there was a wide range of ability among subjects. This method has the potential to contribute to pediatric anesthesia performance assessment, but additional measures of validity including correlations with more direct measures of clinical performance are needed to establish the utility of this approach (Figs 1 and 2, Table 1).

Figure 1 Mean key action scores by scenario and pediatric anesthesia experience. The total key action scores out of 100% for the simulation scenarios for each group of trainees with either less (red bars) or more (blue bars) than 2 months of pediatric anesthesia training. For interpretation of the references to color in this figure legend, the reader is referred to web version of this article. (Reprinted from Fehr JJ, Boulet JR, Waldrop WB, et al. Simulation-based assessment of pediatric anesthesia skills. Anesthesiology. 2011;115:1308-1315, with permission from the American Society of Anesthesiologists, Inc.)

Figure 2 Total key action score by participant. The total key action scores achieved by each trainee with either less (red squares) or more (blue squares) than 2 months of pediatric anesthesia training. Each point represents a specific trainee’s percent overall score. The scores are scattered to highlight both the overlap and the score variation that occurs among individuals within and between groups. For interpretation of the references to color in this figure legend, the reader is referred to web version of this article. (Reprinted from Fehr JJ, Boulet JR, Waldrop WB, et al. Simulation-based assessment of pediatric anesthesia skills. Anesthesiology. 2011;115:1308-1315, with permission from the American Society of Anesthesiologists, Inc.)

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