Evaluation of anesthesiology residents in the diagnosis and control of malignant hyperthermia: comparison of three scenarios of realistic simulation ‒ a crosssectional controlled study
Avaliação de residentes de anestesiologia no diagnóstico e controle da hipertermia maligna: comparação de três cenários de simulação realística – um estudo transversal controlado
Mariana F.L. Neville, Victor Guimaraes de Almeida, Pamela Vieira Andrade, Joilson Moura Santos, Masashi Munechika, David Ferez, Mary dos Santos Silva, Leonardo Ayres Canga, Ana Cristina Tripoloni, Thierry Girard, Helga Cristina Almeida da Silva
Abstract
Introduciton
Simulation-based training is particularly beneficial for rare and life-threatening diseases such as Malignant Hyperthermia (MH). In addition, cognitive aids, including flowcharts and checklists, can be used as guidance in crisis, reducing cognitive demand and simplifying patient care. We assessed the technical and non-technical performance of anesthesiology residents when diagnosing and treating a hypothetical case of MH in three different scenarios.
Methods
This was an observational, cross-sectional, and controlled study. Pairs of anesthesiology residents participated in a validated high-fidelity MH realistic simulation in one of three different scenarios: 1) Control (no access to cognitive aids), 2) Poster, or 3) Mobile application. Both poster and mobile application provided a flowchart and information related to MH diagnosis and treatment. Demographic data, perceived stress levels, and technical and non-technical skills were registered and compared among the groups.
Results
Thirty residents (5-pairs for each scenario) participated in the simulations. The mean score in the technical skill survey was significantly higher in the poster and mobile application groups compared with the control group (83 [4.4], 83 [3.8], and 74 [8.2], respectively, ANOVA, p = 0.047). A significantly higher score for non-technical skills was also found for the poster and mobile application groups compared with the control group (55 [2.5], 57 [0.8], 52 [2.1], respectively, ANOVA, p = 0.03).
Conclusion
In a realistic high-fidelity MH simulation, the participants had satisfactory performance regarding technical and non-technical skills. However, the groups with access to cognitive aids achieved better scores, with no difference between the groups with access to the MH poster and the MH mobile application.
Keywords
Resumo
Introdução
O treinamento baseado em simulação é particularmente benéfico para doenças raras e potencialmente fatais, como a Hipertermia Maligna (MH). Além disso, auxílios cognitivos — incluindo fluxogramas e listas de verificação — podem ser utilizados como guias durante crises, reduzindo a carga cognitiva e simplificando o atendimento ao paciente. Avaliamos o desempenho técnico e não técnico de residentes de anestesiologia ao diagnosticar e tratar um caso hipotético de MH em três cenários diferentes.
Métodos
Trata-se de um estudo observacional, transversal e controlado. Pares de residentes de anestesiologia participaram de uma simulação realística validada de MH com alta fidelidade em um dos três cenários: 1) Controle (sem acesso a auxílios cognitivos); 2) Pôster; ou 3) Aplicativo móvel. Tanto o pôster quanto o aplicativo móvel forneciam um fluxograma e informações relacionadas ao diagnóstico e tratamento da MH. Foram registrados e comparados entre os grupos dados demográficos, níveis de estresse percebido, além de habilidades técnicas e não técnicas.
Resultados
Trinta residentes (5 pares para cada cenário) participaram das simulações. A média das pontuações na avaliação de habilidades técnicas foi significativamente maior nos grupos pôster e aplicativo móvel em comparação com o grupo controle (83 [4,4], 83 [3,8] e 74 [8,2], respectivamente; ANOVA, p = 0,047). Também foi observada uma pontuação significativamente maior para habilidades não técnicas nos grupos pôster e aplicativo móvel em relação ao grupo controle (55 [2,5], 57 [0,8] e 52 [2,1], respectivamente; ANOVA, p = 0,03).
Conclusão
Em uma simulação realística de MH com alta fidelidade, os participantes apresentaram desempenho satisfatório em relação às habilidades técnicas e não técnicas. No entanto, os grupos com acesso a auxílios cognitivos obtiveram melhores resultados, sem diferença entre o grupo que utilizou o pôster e o grupo que utilizou o aplicativo móvel.
Palavras-chave
References
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Submitted date:
10/07/2024
Accepted date:
02/28/2025
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