ARTICLE

Study in a Simulated Scenario of the Influence of Training and Personality in the Resolution of Critical Situations in Anaesthesiology Residents

A B S T R A C T

Introduction: Empowerment of simulations in emergent situations by resident medical interns has positively demonstrated the acquisition of clinical skills [1]. Even so, it remains unclear what psychological factors influence when assuming leadership in carrying out these simulations or in a real situation. This study aims to analyse, by simulating critical situations in the operating room, the influence of training and personality among anaesthesiology residents on the predisposition to assume such leadership.
Materials and Methods: A study was carried out on 22 residents both trained (11) and untrained in simulation, assessing their personality and degree of stress using the Typi and Stay Trait. By observation it was determined that he was the leader, when entering a simulated model of ventricular fibrillation in pairs. Resolution capacity was not valued, but rather the characteristics that define the personality of the resident who assumed leadership.
Results: Regarding personality, measured with the TIPI test, the leaders turned out to score high in agreeableness but low in extraversion compared to the helpers. This suggests that they are altruistic, compassionate, trusting, frank, empathic and sensitive to others and on the other hand reserved, socially distant except with close friends. In the trained group, the Stai Trait test revealed a slightly lower mean in helpers compared to the total mean, in addition to a significantly higher SD in leaders (4.57) than in helpers (2.87), obtaining a p> 0.02. In Stai Estado, the opposite occurred in terms of the averages, lower in the group of leaders with respect to the global average. And a very similar SD was obtained in both groups (4.91 and 4.21). In the TIPI test, the leading group stands out with a low score in extraversion, compared to the total mean and compared to assistants, justified data with a p>0.02.
Conclusion: The residents of the trained group turned out to have lower anxiety in the stressful situation of the simulation compared to the other group. In addition, the women who turned out to be leaders in the trained group demonstrated control of the situation with lower HRs than the leaders in the untrained group, thus demonstrating the influence of training in resolving critical situations.

Keywords

Simulation, residents of anesthesiology, leadership, personality

Introduction

Empowerment of simulations in emergent situations by resident medical interns has positively demonstrated the acquisition of clinical skills [1]. Even so, it remains unclear what psychological factors influence when assuming leadership in carrying out these simulations or in a real situation. This study aims to analyse, by simulating critical situations in the operating room, the influence of training and personality among anaesthesiology residents on the predisposition to assume such leadership.

Materials and Methods

I Study Design

Prospective experimental study.

II Scenery

The study was conducted in the skills classroom of the Hospital Universitario Arnau de Vilanova de Lleida. Spain (HUAV) teaching unit.

III Selection of Participants

The participants included in the study were 11 anaesthesiology residents from HUAV and 10 anaesthesiology residents from outside HUAV.

IV Simulation Development

One day the residents outside the HUAV were summoned to carry out the simulations with them and another day the residents of the HUAV were summoned.

Just before starting the simulation and going to the skills room, the participants met and the specific case was explained. Once the presentation was over, 3 of the participants were taken to a room to change their clothes and be ready to proceed to the start of the simulation. At the same time, before starting the simulation, their baseline constants (HR, BP, SpO2) were measured and recorded in a table (Annex 1). They were also asked to fill out two psychological tests: Tipi (Annex 2), to detect personality type, and Stai Trait (Annex 3), to determine the latent anxiety of each participant.

Upon entering the room, a critical situation lasting 18 minutes developed, in which the participants made their resolution, without any external influence. There, it was determined who was the leader, by means of observation, and their HR and SpO2 were also taken during the resolution of the case. At the end of the simulation, the baseline constants (HR, BP, SpO2) were determined again, as well as the Stai State test (Annex 4).

As differentiating characteristics between the two groups of residents, it must be taken into account that those of the HUAV had training in the same classroom in other critical situations. On the other hand, the residents outside the HUAV had never faced this type of situation, more than the theoretical knowledge that each of them might have.

V Descriptive Analysis

i Trained Group

Of the 11 residents in the trained group, 6 were women and 5 men. These 11 residents were grouped in pairs (boy-girl) plus an R2 who joined one of them. In this group, the baseline constants could not be recorded since the teaching unit remained closed due to the Covid-19 pandemic. Therefore, these tables could not be made either. In the TIPI test, male and female residents clearly differed in neuroticism, with p>0.02. Men scored higher on this personality with M=4. Women had a very low standard deviation in consciousness and men in neuroticism. In the Stai Trait and Stai State tests, it is evident that the majority of women (4 of the 6) are in the 50-75 percentile, which is equivalent to a level of “medium anxiety”. In the group of men, the distribution is more heterogeneous, with 3 men in this percentile 50-75 and 2 in other different percentiles.

ii Untrained Group

Of the 10 residents in the untrained group, 6 were women and 4 men. Of these 10 residents, 3 were leaders. Of the 3 leaders, 2 turned out to be women and 1 was a man. Table 3 shows the data on the baseline constants of the residents. Regarding HR: HR pre (M=83 and SD=18.398), HR intra (M=93 and SD=16.997), HR post (M=79 and SD= 15.342). The TAS pre (M=130 and SD=18.699), the TAS post (M=137 and SD 17.859). The pre DAT (M=78 and SD=9.700), the post DAT (M=83.5 and SD= 8.708). Finally, the SpO2 results were: SpO2 pre (M= 98.8 and SD= 1.229), SpO2 intra (M= 96.5 and SD= 1.715) and SpO2 post (M= 97.9 and SD= 1.197). In (Table 5), in the TIPI test, the following results were obtained in terms of the 5 spheres it covers (“the big five”): extraversion (M= 4.15 and SD= 1.354), agreeableness (M= 5 and SD = 1.247), responsibility (M= 4.85 and SD= 1.292). Neuroticism (M= 4.7 and SD= 1.183) and openness to experience (M=5.25 and SD= 0.857). In the psychological analysis of anxiety, the mean score was 28.9 with a SD of 3.14 in Stai Trait (Table 6), 3 participants turned out to have a "high" level of anxiety and the remaining 7 had a "medium" level of anxiety. In the State Stai (Table 7) the mean score was 25 and SD 3.055. the 10 participants were found to have a “medium” level of anxiety.

VI Comparative Analysis

First, the different parameters were compared between women and men: (Table 4) compares the physiological parameters in the different sexes. It can be seen that the HR both at the initial, middle and final moments is higher in women than in men. The opposite occurs in TAS and TAD, which is higher in men.

Second, leaders and helpers were compared. Both in the untrained group and in the trained group, the leadership was mostly by women. It was also observed that the leaders obtained higher HR at all times of the study. The final HR was also higher than the first in the leaders, unlike in the helpers, which was lower all the time.

Discussion

In the untrained group, in the Stai tests that perceive the degree of anxiety, the leaders and the assistants had the same level of anxiety in the Stai State. In the Stai Rasgo there were 3 of the helpers who obtained a higher level of anxiety than the leaders. Regarding personality, measured with the TIPI test, the leaders turned out to score high in agreeableness but low in extraversion compared to the helpers. This suggests that they are altruistic, compassionate, trusting, frank, empathic and sensitive to others and on the other hand reserved, socially distant except with close friends. In the trained group, the Stai Trait test revealed a slightly lower mean in helpers compared to the total mean, in addition to a significantly higher SD in leaders (4.57) than in helpers (2.87), obtaining a p> 0.02. In Stai Estado, the opposite occurred in terms of the averages, lower in the group of leaders with respect to the global average. And a very similar SD was obtained in both groups (4.91 and 4.21). In the TIPI test, the leading group stands out with a low score in extraversion, compared to the total mean and compared to assistants, justified data with a p>0.02. Helpers scored higher on friendliness, conscientiousness, and openness to experience.

Conclusion

The residents of the trained group turned out to have lower anxiety in the stressful situation of the simulation compared to the other group. In addition, the women who turned out to be leaders in the trained group demonstrated control of the situation with lower HRs than the leaders in the untrained group, thus demonstrating the influence of training in resolving critical situations.

In personality tests, the leaders turned out to be the least extroverted. On the other hand, men stood out in neuroticism, thus reflecting more emotional instability, both in one and in the other group. Therefore, we conclude that continuous training can promote greater self-control and mastery when facing real critical situations.

ARTICLE INFO

Download PDF View PDF

Article Info

Article Type

Research Article

Publication history

Received:

Accepted:

Published:

Copyright

© 2023 Sistac Ballarín JM. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.

DOI: 10.31487/j.ACR.2022.04.01

AUTHOR INFO

Author Info

Sistac Ballarín JM

Lliteras M

Sistac Palacin JM

Corresponding Author

Sistac Ballarín JM
Arnau de Vilanova University Hospital, Lleida, Spain

FIGURES & TABLES

REFERENCE

1.     Girzadas D, Delis S, Bose S, Hall J, Rzechula K et al. (2009) Measures of stress and learning seem to be equally affected among all roles in a simulation scenario. Simul Healthc 4: 149-154. [Crossref]

2.     Kim J, Hur M, Kim H (2018) The efficacy of simulation-based and peer-learning handover training for new graduate nurses. Nurse Educ Today 69: 14-19. [Crossref]

3.     Sigwalt F, Petit G, Evain J, Claverie D, Bui M et al. (2020) Stress Management Training Improves Overall Performance during Critical Simulated Situations: A Prospective Randomized Controlled Trial. Anesthesiology 133: 198-211. [Crossref]

4.     Vortman R (2020) Using Simulation‐Based Education to Improve Team Communication During a Massive Transfusion Protocol in the OR. AORN J 111: 393-400. [Crossref]

5.     Grant V, Wolff M, Adler M (2016) The Past, Present, and Future of Simulation-based Education for Pediatric Emergency Medicine. Clin Pediatr Emerg Med 17: 159-168. [Crossref]

6.     Naggar M, Almaeen A (2020) Student's perception towards medical-simulation training as a method for clinical teaching. J Pak Med Assoc 70: 618-623. [Crossref]

7.     Ruetzler K, Smereka J, Abelairas Gomez C, Frass M, Dabrowski M et al. (2020) Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial. BMC Anesthesiol 20: 90. [Crossref]

8.     Bhagwat M (2012) Simulation and anaesthesia. Indian J Anaesth 56: 14-20. [Crossref]

9.     Schwid H, OʼDonnell D (1992) Anesthesiologists' management of simulated critical incidents. Anesthesiology 76: 495-501. [Crossref]

10. Kolawole H, Guttormsen A, Hepner D, Kroigaard M, Marshall S (2019) Use of simulation to improve management of perioperative anaphylaxis: a narrative review. Br J Anaesth 123: e104-e109. [Crossref]