Exposure to Simulated Mortality Affects Resident Performance during Assessment Scenarios

Background The utility of simulated mortality remains controversial in the literature. We therefore sought primarily to determine whether there was a difference in performance for residents exposed to varying levels of simulated mortality during training scenarios. As a secondary objective, we also sought to determine whether their self-reported anxiety levels, attitudes toward, and engagement in the simulated encounters differed based on group assignment. Methods Fifty junior anesthesiology residents were randomized to one of the three simulation cohorts. The residents were broken into groups that either always experienced simulated patient survival (never death), always experienced simulated mortality (always death), or had a variable result based on performance (variable death). All residents experienced 12 identical training simulations with only the predetermined outcome as the variable. Residents were brought back 6 weeks after initial training for four assessment scenarios and subsequently rated on nontechnical skills and anxiety levels. Results Residents in the always and never death groups showed no difference in nontechnical skills using the Anesthetists' Nontechnical Skills Score before and after the simulations. Residents in the variable death group, however, had improved nontechnical skill scores when brought back for the assessment (45.2 vs 41.5 and 42.9 respectively, P = 0.01). Although all three groups had higher State-Trait Anxiety Index scores from baseline after training, only the always death group had higher anxiety scores during the assessment (43 vs 37 vs 37 P = 0.008). Conclusions We found that participants who experienced simulated mortality that was variably delivered, and more directly related to performance, performed better on later assessment scenarios.