Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes. (April 2018)

• Record Type: Journal Article
• Authors: Blum, Richard H.; Muret-Wagstaff, Sharon L.; Boulet, John R.; Cooper, Jeffrey B.; Petrusa, Emil R.; Baker, Keith H.; Davidyuk, Galina; Dearden, Jennifer L.; Feinstein, David M.; Jones, Stephanie B.; Kimball, William R.; Mitchell, John D.; Nadelberg, Robert L.; Wiser, Sarah H.; Albrecht, Meredith A.; Anastasi, Amanda K.; Bose, Ruma R.; Chang, Laura Y.; Culley, Deborah J.; Fisher, Lauren J.; Grover, Meera; Klainer, Suzanne B.; Kveraga, Rikante 0.; Martel, Jeffrey P.; McKenna, Shannon S.; Minehart, Rebecca D.; Mitchell, John D.; Mountjoy, Jeremi R.; Pawlowski, John B.; Pilon, Robert N.; Shook, Douglas C.; Silver, David A.; Warfield, Carol A.; Zaleski, Katherine L.;
• Is Part Of: Anesthesiology. Volume 128:Number 4(2018)
• Publication Date: 2018-04
• Subjects: Anesthesiology -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1097/ALN.0000000000002091
• Languages: English
• ISSNs: 0003-3022

Abstract

Abstract : Background: Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment. Methods: Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorally anchored rating scale for five domains: (1) formulate a clear plan, (2) modify the plan under changing conditions, (3) communicate effectively, (4) identify performance improvement opportunities, and (5) recognize limits. A second rater assessed 10% of encounters. Scores and variances for each domain, each scenario, and the total were compared. Low domain ratings (1, 2) were examined in detail. Results: Interrater agreement was 0.76; reliability of the seven-scenario assessment was r = 0.70. CA-3s had a significantly higher average total score (4.9 ± 1.1 vs . 4.6 ± 1.1, P = 0.01, effect size = 0.33). CA-3s significantly outscored CA-1s for five of seven scenarios and domains 1, 2, and 3. CA-1s had a significantly higher proportion of worrisome ratings than CA-3s (chi-square = 24.1, P < 0.01, effect size = 1.50). Ninety-eight percent of residents rated the simulations more educational than an average day in the operating room. Conclusions: Sensitivity of the assessment to CA-1 versus CA-3 performance differences for most scenarios and domains supports validity. No differences, by experience level, were detected for two domains associated with reflective practice. Smaller score variances for CA-3s likely reflect a training effect; however, worrisome performance scores for both CA-1s and CA-3s suggest room for improvement. Abstract : This investigation administered the seven-scenario assessment to a larger sample of first-year and third-year residents from three training programs in three different simulation centers. The assessment had good reliability and interrater agreement, further validating the technique. Third-year residents significantly outscored first-year residents for five of seven scenarios, and the vast majority of residents found the simulations more educational than an average day in the operating room.