YERİNDE SİMÜLASYONUN ANESTEZİ VE REANİMASYON UZMANLARININ TEKNİK OLMAYAN BECERİLERİNE VE HASTA GÜVENLİĞİNE ETKİSİ

Abstract

In situ simulation training is recognized as an effective method for enhancing anesthesiology and reanimation specialists’ non-technical skills (NTS) and improving patient safety. However, studies investigating the integration of this educational approach into continuous professional development programs and its translation into clinical practice remain limited. This study aimed to evaluate the effect of in situ simulation training on the non-technical skill levels and patient safety performance of anesthesiology and reanimation specialists working in a pediatric operating room, as well as to obtain their feedback regarding the training. Additionally, the study examined whether performance observed during in situ simulation scenarios reflected real clinical performance. This observational, single-group quasi-experimental (pre–post) study was conducted between 2023 and 2024 in the operating rooms of a tertiary pediatric hospital. Eight in situ simulation sessions were held with eight anesthesiology and reanimation specialists working in the pediatric operating room. Changes in participants’ non-technical skills were assessed through observations conducted in the real operating room before and after the simulation training. To evaluate the impact of in situ simulation on patient safety, intraoperative team performance assessments and post-anesthesia care unit (PACU) observations were also performed.Data were collected using the Participant Information Form, Observation Data Form, Turkish version of the Anaesthetists’ Non-Technical Skills Assessment Tool – Danish version (ANTSdk/ANTStr), In Situ Simulation Training Evaluation Form, Intraoperative Patient Safety Evaluation Form, and Post-Anesthesia Care Unit Patient Safety Evaluation Form. Simulation video recordings were independently rated by two evaluators and compared with prior in situ simulation real-case observations to assess the consistency between simulated and clinical settings. Descriptive statistics (number, percentage, median, mean, standard deviation) were calculated, and repeated-measures ANOVA, Wilcoxon, and McNemar tests were applied. Findings indicated no statistically significant difference in anesthesiologists’ non-technical skill levels before and after simulation (p> 0.05). Likewise, intraoperative patient safety performance, as rated by team members, showed no significant change (p> 0.05). However, significant improvements were observed in the PACU for parameters such as bronchospasm, aspiration, consciousness level, and bleeding control (p <0.001), while no differences were found for other variables (p > 0.05). No significant difference was found between anesthesiology and reanimation specialists’ non-technical skill scores in real and simulated cases prior to the in situ simulation(p > 0.05). Participants evaluated their in situ simulation experience positively and expressed satisfaction with the training. In conclusion, a single in situ simulation session did not significantly improve non-technical skill performance but was associated with improvements in certain patient safety indicators within the post-anesthesia care unit. The consistent performance observed across real and simulated settings suggests that participants exhibited clinical behaviors in the simulation environment similar to those demonstrated in actual practice.