Abstract
Purpose: Simulation centres, where trainees can practise technical procedures on models of varying fidelity, provide a training option that allows them to acquire skills in a controlled environment prior to clinical performance. It has been proposed that the time to complete a simulator task may translate to proficiency in the clinical setting. The objective of this study was to determine whether time to complete a simulator task translates to clinical fibreoptic manipulation (FOM) performance.
Methods: Thirty registered respiratory therapists at a teaching hospital were recruited as subjects for a single-blinded randomized trial. Subjects were randomized to training on either a low fidelity (n=15) or high fidelity (n=15) model. After training, each subject was tested for the time required to complete a specific task on his/her respective model. Subjects then performed a fibreoptic orotracheal intubation (FOI) on healthy, consenting, and anesthetised patients requiring intubation for elective surgery. Performance was measured independently by blinded examiners using a checklist and global rating scale (GRS); and time was measured from insertion of the fibreoptic scope to visualization of the carina. Data were analyzed using Spearman rank order correlation coefficients.
Results: There was no correlation between the time to complete a task on either the high or low fidelity simulators, and the clinical FOI performance as assessed by a checklist, GRS, and time to complete the FOM (allP=NS).
Conclusion: These results suggest that simulator-based, task-orientated time measurement may not be a good indicator of FOI performance in the clinical setting.
Résumé
Objectif: Les centres de simulation, où les stagiaires peuvent s’exercer à réaliser des gestes techniques sur des modèles d’une fidélité variable, constituent une alternative de formation qui leur permet d’acquérir des compétences dans un environnement contrôlé et ce, avant de travailler dans un environnement clinique. Il a été suggéré que le temps nécessaire à compléter une tâche dans un simulateur pourrait refléter l’aptitude dans un contexte clinique. L’objectif de cette étude était de déterminer si le temps utilisé pour compléter une tâche dans un simulateur se traduisait en performance de manipulation fibroscopique (FOM) clinique.
Méthode: Trente inhalothérapeutes certifiés oeuvrant dans un hôpital universitaire ont été recrutés pour participer à cette étude randomisée en simple aveugle. Les sujets ont été randomisés à s’entraîner soit avec un modèle peu fidèle (n=15) ou très fidèle (n=15). Après la formation, chaque sujet a été testé par rapport au temps requis pour compléter une tâche spécifique sur son modèle respectif. Les sujets ont ensuite réalisé une intubation orotrachéale par fibroscopie (FOI) sur des patients sains, consen-tants et anesthésiés nécessitant une intubation pour une chirurgie élective. La performance a été mesurée de façon indépendante par des examinateurs en aveugle à l’aide d’une liste de contrôle et une échelle d’évaluation générale (GRS); le laps de temps écoulé entre l’insertion du fibroscope et la visualisation de la carène a été mesuré. Les données ont été analysées à l’aide des coefficients de corrélation des rangs de Spearman.
Résultats: Il n’y a pas eu de corrélation entre le temps nécessaire à compléter une tâche sur les simulateurs, qu’ils soient très fidèles ou peu fidèles, et la performance d’intubation par fibroscopie telle que mesurée par une liste de contrôle, le GRS, et le temps pour effectuer la FOM (tous P=NS).
Conclusion: Ces résultats suggèrent que le chronométrage basé sur simulateur et centré sur la tâche ne constitue pas un bon indice de la performance de FOI dans un contexte clinique.
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Study performed at St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.
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Crabtree, N.A., Chandra, D.B., Weiss, I.D. et al. Fibreoptic airway training: correlation of simulator performance and clinical skill. Can J Anesth 55, 100–104 (2008). https://doi.org/10.1007/BF03016321
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DOI: https://doi.org/10.1007/BF03016321