Strategy to Develop a Common Simulation Training Program: Illustration with Anesthesia and Intensive Care Residency in France

Abstract

Phenomenon: The urgency of having fair and trustworthy competency-based assessment in medical training is growing. Simulation is increasingly recognized as a potent method for building and assessing applied competencies. The growing use of simulation and its application in summative assessment calls for comprehensive and rigorously designed programs. Defining the current baseline of what is available and feasible is a crucial first step. This paper uses anesthesia and intensive care (AIC) in France as a case study in how to document this baseline. Approach: An IRB-approved, online anonymous closed survey was submitted to AIC residency program directors and AIC simulation program directors in France from January to February 2021. The researcher-developed survey consisted of 65 questions across five sections: centers' characteristics, curricular characteristics, courses' characteristics, instructors' characteristics, and simulation perceptions and perspectives. Findings: The participation rate was 31/31 (100%) with 29 centers affiliated with a university hospital. All centers had AIC simulation activities. Resident training was structured in 94% of centers. Simulation uses were training (100%), research and development (61%), procedural or organizational testing (42%), and summative assessment (13%). Interprofessional full-scale simulation training existed in 90% of centers. Procedural training on simulators prior to clinical patients' care was performed “always” in 16%, “most often” in 45%, “sometimes” in 29% and “rarely” or “not” in 10% of centers. Simulated patients were used in 61% of centers. Main themes were identified for procedural skills, full-scale and simulated patient simulation training. Simulation activity was perceived as increasing in 68% of centers. Centers expressed a desire to participate in developing and using a national common AIC simulation program. Insights: Based on our findings in AIC, we demonstrated a baseline description of nationwide simulation activities. We now have a clearer perspective on a decentralized approach in which individual institutions or regional consortia conduct simulation for a discipline in a relatively homogeneous way, suggesting the feasibility for national guidelines. This approach provides useful clues for AIC and other disciplines to develop a comprehensive and meaningful program matching existing expectations and closing the identified gaps.

Keywords:

• Internship and residency
• curriculum
• simulation
• education
• anesthesia
• competency-based education

Acknowledgments

The authors thank all AIC residency program directors and AIC simulation program directors from the simulation centers and University Hospitals in France who have contributed to this work. The authors thank François Lecomte and Guillaume Der Sahakian for their review and help with the survey questionnaire.

Authors' contributions

CB helped with study conception and design, data contribution, data analysis, data interpretation, writing, visualization, and review and editing. RDM helped with study design refinement, data contribution, data interpretation, writing, and review and editing. JWR and DB helped with data interpretation, writing, and review and editing. AB, ML and JP helped with study conception and design, data and review and editing BP, and JP helped with review and editing. All authors read and approved the final manuscript.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files] or available on reasonable request.

Declaration of interest statement

The authors declare that they have no competing interests.

Additional information

Funding

This work is a part of CB PhD which have been support by grants from the French Society for Anesthesiology and Intensive Care (SFAR), The Arthur Sachs-Harvard Foundation, The University Hospital of Caen, The North-West University Hospitals Group (G4), The Charles Nicolle Foundation. Funding bodies did not have any role in the design of the study, collection, analysis, and interpretation of data and in writing the manuscript.