Clinical Performance and Multitasking in Anesthesia : a Simulation-based Study

This study is a prospective, single-center, non-interventional study. The study was classified as non-interventional by the institutional research committee, as the intervention consists of simulation training and the study population comprises healthcare practitioners.

The study participants are anesthesiologists, including attending physicians and residents. Each participant will serve as their own control. The study will comprise two visits: one intervention visit consisting of a multitasking simulation session, and one control visit involving clinical questions administered under quiet conditions. The order of the visits will be randomized between participants using a crossover design in order to minimize potential learning bias.

The multitasking condition will consist of performing manual mask ventilation on a manikin while answering oral clinical questions administered in the form of Script Concordance Tests (SCTs). Participants will be instructed to ventilate the manikin with a tidal volume of 500 mL and a respiratory rate of 15 breaths/minute.

Clinical reasoning under quiet conditions will consist of answering oral clinical questions in the SCT format.

The study will use a 44-item Script Concordance Test (SCT) distributed across 20 anesthesiology clinical vignettes. The vignettes are distributed as follows: 8 vignettes with 3 items, 8 vignettes with 2 items, and 4 vignettes with 1 item. The vignettes were adapted, without modification of their content, to be compatible with oral administration and the simulation scenario.

In addition, for each participant, the SCT clinical vignettes will be randomized between the "simulation vignettes" and the "control vignettes," with stratification according to the number of items per vignette. Five vignettes will be allocated to the intervention condition and fifteen to the control condition. This approach will help limit the effect of differences in vignette difficulty that could otherwise bias the results. At the group level, all clinical vignettes will ultimately be assessed in both the simulation and control conditions.

Detailed information is available in the study protocol.

• Manual ventilation performance assessed by variance of expiratory tidal volume (ml) [Time frame: - Training before simulation: baseline - During simulation: ventilation only, ventilation plus clinical questions]
• Manual ventilation performance assessed by variance of respiratory rate (cycles/minute) [Time frame: - Training before simulation: baseline - During simulation: ventilation only, ventilation plus clinical questions]
• Cognitive load assessed by the NASA-TLX index (score out of 100) [Time frame: A two time points: - Evaluating cognitive load of manual ventilation alone, before simulation after training. - Evaluation cognitive load of multitasking, at the end of the simulation session]
• Time to answer items of the script concordance test (seconds) [Time frame: Two time points: intervention and control.]