Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
Simul Healthc. 2011 Oct;6(5):255-9. doi: 10.1097/SIH.0b013e31821dfd05.
Human factors have been identified as root causes of human error in medicine. The "Anesthetists' Non-Technical Skills (ANTS) system" evaluates the effect of simulation training and debriefing on nontechnical skills (NTS). Studies suggest that residents' NTS may improve after simulation training but the effect on NTS of practicing anesthesiologists is unclear. The purpose of this study was to determine whether high-fidelity simulation training and debriefing improved the NTS of practicing anesthesiologists using the ANTS tool.
In a previous study, 67 practicing anesthesiologists managed a 45-minute standardized anesthetic case using high-fidelity simulation and returned 5 to 9 months later to manage a second case. After Research Ethics Board approval, two blinded video reviewers, trained in the use of the ANTS system, evaluated archived videotapes of the 59 subjects who completed both sessions. Results were analyzed with a mixed-design analysis of variance. Interrater reliability was calculated using the intraclass correlation coefficient.
Interrater reliability for the ANTS scoring was 0.436, P < 0.05. Overall, ANTS scores improved approximately 5% from session 1 to 2 (P < 0.01), but there was no effect due to debriefing. The situational awareness ANTS category showed a statistically significant effect of debriefing (P < 0.05).
The relatively short simulation intervention, the length of time until the posttest was completed, well-developed NTS in practicing physicians, and a tool that might not be the optimal method of measurement may all account for the lack of improvement in NTS of practicing anesthesiologists as demonstrated in this study.
人为因素已被确定为医学中人为错误的根本原因。“麻醉师非技术技能（ANTS）系统”评估模拟培训和汇报对非技术技能（NTS）的影响。研究表明，住院医师的 NTS 可能在模拟培训后得到提高，但实践麻醉师的 NTS 影响尚不清楚。本研究旨在确定使用 ANTS 工具进行高保真模拟培训和汇报是否能提高实践麻醉师的 NTS。
在之前的一项研究中，67 名实践麻醉师使用高保真模拟管理了一个 45 分钟的标准化麻醉病例，并在 5 至 9 个月后返回管理第二个病例。在获得研究伦理委员会批准后，两名经过 ANTS 系统使用培训的盲审视频评论员评估了完成两次会议的 59 名受试者的存档录像带。使用混合设计方差分析分析结果。使用组内相关系数计算 ANTS 评分的组内相关性。
ANTS 评分的组内相关性为 0.436，P<0.05。总体而言，ANTS 评分从第 1 次会议到第 2 次会议提高了约 5%（P<0.01），但汇报没有效果。情境意识 ANTS 类别显示汇报具有统计学意义的效果（P<0.05）。
相对较短的模拟干预、完成后测所需的时间、实践医生中高度发达的 NTS 以及可能不是最佳测量方法的工具，都可能导致本研究中实践麻醉师的 NTS 没有得到改善。
