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Background: The embedded participant (EP) plays a key role during a full scale/high-fidelity simulation (HFS) session. He/she is expected to guide the learner towards the achievement of the educational objectives of the scenario. However, his/her influence on learners' performance stands undetermined and this effect remains briefly addressed in the literature. This study primarily aims to assess whether the EP could have an influence on the performance of the learner during a HFS scenario. The secondary aim was to establish an inventory of the EP practices in France., Methods: This retrospective study was conducted in Lyon Claude Bernard University Health Simulation Centre (France). Anaesthesia and critical care residents in postgraduate years 1 to 5 who were scheduled for their HFS sessions during the 2016 to 2021 academic years were included. Two investigators independently evaluated the resident performance regarding both technical and non-technical skills from video recordings. In addition, a nationwide survey was sent out by email through the networks of the Francophone Healthcare Simulation Society (SoFraSimS, Société Francophone de Simulation en Santé) to collect information on EP practices in French-speaking Simulation centres., Results: From a total of 344 HFS videos analysed, a cohort of 19 experienced EPs was identified. The EPs had an influence on the technical and non-technical performances of the learners. The 147 responses to the survey showed that predefined rules of EP good practice existed in only 36% of the simulation centres and 65% of respondents believed that specific EP training would be justified., Conclusion: The EP can exert an influence on the performance of the learners during HFS. For acting as an EP, a great variability of practices and a lack of training are reported by professionals working in simulation centres. These results suggest that more attention must be paid to EP training and attitudes during simulation, especially if summative simulations are extensively developed., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: High-fidelity simulation improves participant learning through immersive participation in a stressful situation. Stress management training might help participants to improve performance. The hypothesis of this work was that Tactics to Optimize the Potential, a stress management program, could improve resident performance during simulation., Methods: Residents participating in high-fidelity simulation were randomized into two parallel arms (Tactics to Optimize the Potential or control) and actively participated in one scenario. Only residents from the Tactics to Optimize the Potential group received specific training a few weeks before simulation and a 5-min reactivation just before beginning the scenario. The primary endpoint was the overall performance during simulation measured as a composite score (from 0 to 100) combining a specific clinical score with two nontechnical scores (the Ottawa Global Rating Scale and the Team Emergency Assessment Measure scores) rated for each resident by four blinded independent investigators. Secondary endpoints included stress level, as assessed by the Visual Analogue Scale during simulation., Results: Of the 134 residents randomized, 128 were included in the analysis. The overall performance (mean ± SD) was higher in the Tactics to Optimize the Potential group (59 ± 10) as compared with controls ([54 ± 10], difference, 5 [95% CI, 1 to 9]; P = 0.010; effect size, 0.50 [95% CI, 0.16 to 0.91]). After specific preparation, the median Visual Analogue Scale was 17% lower in the Tactics to Optimize the Potential group (52 [42 to 64]) than in the control group (63 [50 to 73]; difference, -10 [95% CI, -16 to -3]; P = 0.005; effect size, 0.44 [95% CI, 0.26 to 0.59]., Conclusions: Residents coping with simulated critical situations who have been trained with Tactics to Optimize the Potential showed better overall performance and a decrease in stress level during high-fidelity simulation. The benefits of this stress management training may be explored in actual clinical settings, where a 5-min Tactics to Optimize the Potential reactivation is feasible prior to delivering a specific intervention.

Background and Objectives: Procedural simulation training for difficult airway management offers acquisition opportunities. The hypothesis was that 3 hours of procedural simulation training for difficult airway management improves: acquisition, behavior, and patient outcomes as reported 6 months later., Methods: This prospective comparative study took place in two medical universities. Second-year residents of anesthesiology and intensive care from one region participated in 3h procedural simulation (intervention group). No intervention was scheduled for their peers from the other region (control). Prior to simulation and 6 months later, residents filled-out the same self-assessment form collecting experience with different devices. The control group filled-out the same forms simultaneously. The primary endpoint was the frequency of use of each difficult airway management device within groups at 6 months. Secondary endpoints included modifications of knowledge, skills, and patient outcomes with each device at 6 months. Intervention cost assessment was provided., Results: 44 residents were included in the intervention group and 16 in the control group. No significant difference was observed for the primary endpoint. In the intervention group, improvement of knowledge and skills was observed at 6 months for each device, and improvement of patient outcomes was observed with the use of malleable intubation stylet and Eschmann introducer. No such improvement was observed in the control group. Estimated intervention cost was 406€ per resident., Conclusions: A 3h procedural simulation training for difficult airway management did not improve the frequency of use of devices at 6 months by residents. However, other positive effects suggest exploring the best ratio of time/acquisition efficiency with difficult airway management simulation. CLINICALTRIALS., Gov Identifier: NCT02470195., (Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Planning held before emergency management of a critical situation might be an invaluable asset for optimising team preparation. The purpose of this study was to investigate whether a brief planning discussion improved team performance in a simulated critical care situation. Forty-four pairs of trainees in anaesthesia and intensive care were randomly allocated to either an intervention or control group before participating in a standardised simulated scenario. Twelve different scenarios were utilised. Groups were stratified by postgraduate year and simulated scenario, and a facilitator was embedded in the scenario. In the intervention group, the pairs had an oral briefing followed by a 4-min planning discussion before starting the simulation. The primary end-point was clinical performance, as rated by two independent blinded assessors on a score of 0-100 using video records and pre-established scenario-specific checklists. Crisis resource management and stress response (cognitive appraisal ratio) were also assessed. Two pairs were excluded for technical reasons. Clinical performance scores were higher in the intervention group; mean (SD) 51 (9) points vs. 46 (9) in the control group, p = 0.039. The planning discussion was also associated with higher crisis resource management scores and lower cognitive appraisal ratios, reflecting a positive response. A 4-min planning discussion before a simulated critical care situation improved clinical team performance and cognitive appraisal ratios. Team planning should be integrated into medical education and clinical practice., (© 2019 Association of Anaesthetists.)

Background: High-fidelity simulation is known to improve participant learning and behavioral performance. Simulation scenarios generate stress that affects memory retention and may impact future performance. The authors hypothesized that more participants would recall three or more critical key messages at three months when a relaxation break was performed before debriefing of critical event scenarios., Methods: Each resident actively participated in one scenario and observed another. Residents were randomized in two parallel-arms. The intervention was a 5-min standardized relaxation break immediately before debriefing; controls had no break before debriefing. Five scenario-specific messages were read aloud by instructors during debriefings. Residents were asked by telephone three months later to recall the five messages from their two scenarios, and were scored for each scenario by blinded investigators. The primary endpoint was the number of residents participating actively who recalled three or more messages. Secondary endpoints included: number of residents observing who recalled three or more messages, anxiety level, and debriefing quality., Results: In total, 149 residents were randomized and included. There were 52 of 73 (71%) residents participating actively who recalled three or more messages at three months in the intervention group versus 35 of 76 (46%) among controls (difference: 25% [95% CI, 10 to 40%], P = 0.004). No significant difference was found between groups for observers, anxiety or debriefing quality., Conclusions: There was an additional 25% of active participants who recalled the critical messages at three months when a relaxation break was performed before debriefing of scenarios. Benefits of relaxation to enhance learning should be considered for medical education.

Introduction: Peripheral venous catheter insertion is a procedural skill that every medical student should master. Training is often limited to a small number of students and is poorly evaluated. The objective of this study was to evaluate the performance of peer-assisted learning in comparison to instructor-led teaching for peripheral venous catheter insertion training., Methods: Students were randomized to the control group attending a traditional instructor-led training session (slideshow and demonstration by an anesthetist instructor, followed by training on a procedural simulator) or to the test group attending a peer-assisted training session (slideshow and demonstration video-recorded by the same instructor, followed by training on a procedural simulator). The primary endpoint was the performance of peripheral venous catheter insertion, assessed on procedural simulator one week later by blinded experts using a standardized 20-item grid. Students self-evaluated their confidence levels using a numeric 10-point scale., Results: Eighty-six students were included, 73 of whom attended the assessment session. The median performance score was 12/20 [8-15] in the instructor-led teaching group versus 13/20 [11-15] in the peer-assisted learning group (P=0.430). Confidence levels improved significantly after the assessment session and were significantly higher in the peer-assisted learning group (7.6/10 [7.0-8.0] versus 7.0/10 [5.0-8.0], P=0.026)., Conclusion: Peer-assisted learning is effective for peripheral venous catheter insertion training and can be as effective as instructor-led teaching. Given the large number of students to train, this finding is important for optimizing the cost-effectiveness of peripheral venous catheter insertion training., (Copyright © 2017 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Background: Cognitive aids improve the technical performance of individuals and teams dealing with high-stakes crises. Hand-held electronic cognitive aids have rarely been investigated. A randomized controlled trial was conducted to investigate the effects of a smartphone application, named MAX (for Medical Assistance eXpert), on the technical and non-technical performance of anaesthesia residents dealing with simulated crises., Methods: This single-centre randomized, controlled, unblinded trial was conducted in the simulation centre at Lyon, France. Participants were anaesthesia residents with >1 yr of clinical experience. Each participant had to deal with two different simulated crises with and without the help of a digital cognitive aid. The primary outcome was technical performance, evaluated as adherence to guidelines. Two independent observers remotely assessed performance on video recordings., Results: Fifty-two residents were included between July 2015 and February 2016. Six participants were excluded for technical issues; 46 participants were confronted with a total of 92 high-fidelity simulation scenarios (46 with MAX and 46 without). Mean (sd) age was 27 (1.8) yr and clinical experience 3.2 (1.0) yr. Inter-rater agreement was 0.89 (95% confidence interval 0.85-0.92). Mean technical scores were higher when residents used MAX [82 (11.9) vs 59 (10.8)%; P<0.001]., Conclusion: The use of a hand-held cognitive aid was associated with better technical performance of residents dealing with simulated crises. These findings could help digital cognitive aids to find their way into daily medical practice and improve the quality of health care when dealing with high-stakes crises., Clinical Trial Registration: NCT02678819., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com)

Objectives: High-fidelity simulation (HFS) calls heavily upon cognitive capacities and generates stress and anxiety. The objectives of this prospective, observational study were to assess trait anxiety and fear of negative evaluation (FNE) in anaesthesiology and critical care residents and appraise their state anxiety levels and cardiovascular responses during HFS training sessions., Subjects and Methods: First-year anaesthesiology and critical care residents completed the French-Canadian adaptation of the State-Trait Anxiety Inventory (IASTA Y-1: state anxiety, IASTA Y-2: trait anxiety) and the French adaptation of the Fear of Negative Evaluation Scale (FNE). Their heart rate (HR) and blood pressure (BP) were assessed before and after the training session., Results: Twenty-three residents (8 women, 15 men) were included in the study. IASTA Y-1 and Y-2 scores were low (respectively 40.2±9.9 and 39.7±8) and FNE scores were moderate (16.7±5.5). HR measurements before and after the training sessions were significantly higher than at rest (respectively 78±19, 80±17 and 63±9b/min; P<0.001). BP measurements before and after the HFS sessions were not significantly different. The IASTA Y-2 and FNE scores of female residents were significantly higher than those of male residents (respectively P=0.004 and P=0.049)., Conclusion: First-year anaesthesiology and critical care residents had low trait anxiety and FNE. HFS training increased their HR but not their BP. Their state anxiety also remained low. Several differences between individuals were noted, particularly between men and women., (Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Objective: To analyze the factors influencing the choice of the specialty "anesthesiology and intensive care" by medical students at the end of the second cycle of the French medical curriculum. This study had three aims: to measure the attraction of students for this specialty, to assess the perception of this specialty at this stage of the medical studies, and to study the influence of the teaching of "anesthesiology and intensive care" during this second cycle on student perceptions of the specialty., Study Design: Descriptive study., Material and Methods: We conducted an anonymous survey among 407 medical students who were at the end of their sixth year of their medical studies, and who were enrolled in one of the four schools of medicine in Lyon, France, for the university year 2007-2008., Results: Three hundred and twenty-eight surveys were analyzed. The specialty "anesthesiology and intensive care" was ranked third overall in terms of preferred specialties. Intensive care was rated the most attractive component, and respondents in particular noted its multisystem perspective and perceived utility. Anesthesiology was in general seen as highly technical and potentially lucrative, but holding increased medicolegal risk. The hospital training courses were highly rated by the students, who believed these to be the best way to learn about this specialty. However, respondents indicated that not enough hospital training courses were available, and only training courses in the intensive care units and the prehospital care department led the students towards this specialty. Accordingly, the nature and practice of anesthesiology were less well-known by students., Conclusion: Numerous medical students want to become intensivists. Anesthesiology is less well-known at this stage of the medical studies. The teaching of the "anesthesiology and intensive care" specialty needs to be optimized., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Abstract: Objective: To analyze the factors influencing the choice of the specialty “anesthesiology and intensive care” by medical students at the end of the second cycle of the French medical curriculum. This study had three aims: to measure the attraction of students for this specialty, to assess the perception of this specialty at this stage of the medical studies, and to study the influence of the teaching of “anesthesiology and intensive care” during this second cycle on student perceptions of the specialty. Study design: Descriptive study. Material and methods: We conducted an anonymous survey among 407 medical students who were at the end of their sixth year of their medical studies, and who were enrolled in one of the four schools of medicine in Lyon, France, for the university year 2007–2008. Results: Three hundred and twenty-eight surveys were analyzed. The specialty “anesthesiology and intensive care” was ranked third overall in terms of preferred specialties. Intensive care was rated the most attractive component, and respondents in particular noted its multisystem perspective and perceived utility. Anesthesiology was in general seen as highly technical and potentially lucrative, but holding increased medicolegal risk. The hospital training courses were highly rated by the students, who believed these to be the best way to learn about this specialty. However, respondents indicated that not enough hospital training courses were available, and only training courses in the intensive care units and the prehospital care department led the students towards this specialty. Accordingly, the nature and practice of anesthesiology were less well-known by students. Conclusion: Numerous medical students want to become intensivists. Anesthesiology is less well-known at this stage of the medical studies. The teaching of the “anesthesiology and intensive care” specialty needs to be optimized. [ABSTRACT FROM AUTHOR]