Simulation training in critical care: does practice make perfect?

Background: Few data exist regarding the effectiveness of simulation in resident education in critical care. The purpose of this study was to determine whether multiple-simulation exposure (MSE) or single-simulation exposure (SSE) improved residents' recognition of shock and initial management of the critically ill simulated surgical patient.

Methods: Data were collected at a level 1 trauma center. Surgery, anesthesiology, and emergency medicine residents were given a multiple-choice question (MCQ) pretest before a tutorial on the recognition and management of shock followed by high-fidelity simulation/debriefing and MCQ post-test. MSE residents had 1.5 hours of simulation per resident over 3 days, and SSE residents had 1.5 hours of simulation as a group in 1 day. Pre- and posttest comparisons overall and subgroup analysis for MSE versus SSE were performed.

Results: Data was available for 45 MSE residents and 15 SSE residents. Overall posttest percent correct was greater than pretest percent correct (81% ± 9% vs 75% ± 13%, post- versus pre-, P = .01). Subgroup analysis demonstrated significantly improved post- versus pretest performance for MSE residents only. There were no differences in pre- or posttest performance for MSE residents during the first 4 months of the academic year versus the last 4 months. Pretest performance over 12 months of observation for MSE residents showed no significant differences.

Conclusion: Repeated simulation exposure was more effective than single simulation exposure at improving MCQ performance designed to measure the recognition and management of shock in the critically ill simulated surgical patient. Duration of training did not impact MCQ performance.