The study was conducted in Mekelle University, college of health sciences which is located in Tigray, Ethiopia. The universities anesthesia simulation center was established on January 2019 and has 3 master educators and 6 clinical educators who were trained to run simulations for different groups. A 3-day course was held by department of anesthesia, college of health sciences, Mekelle university and was provided by simulation team for the non-physician anesthetists from 25 May -10 June, 2019.
Anesthetists currently working in different part of Tigray were invited to participate as study subjects. Written informed consent was obtained from participants before data collection, including consent for participation. Refusal of the participation in the study had no consequence on the workshop curriculum.
Nine case scenarios were developed to be conducted. The scenario content was based on set objectives and for each scenario a simulator performance pretest and posttest were created. The pretest and posttest topics included the anesthetic management and recognition of Laryngospasm, Bronchospasm, Total Spinal, Local anesthetic toxicity, Septic shock, Multiple trauma, Maternal hemorrhage, Feta distress, Neonatal resuscitation, Preeclampsia/eclampsia.
Scenarios occurred over approximately 20 minutes, followed by 40 minutes debriefing. All debriefing started with reactions, followed by setting the fact and discussion on problems and solutions. After debriefing was conducted it was followed by short summary of the learning objectives with power point presentation or video demonstration.
Orientation about simulation and rules and regulations was held for all participants before the simulation session starts. During 30 minutes didactics period, medical simulation, patient simulation and rules and regulation were discussed. Participants then were introduced to the VICTORIA® S2200 Package: S2200.PK simulator mannequin, monitors and anesthesia machine and the mock operating room environment.
Data collection and analysis
Identical pretest and posttest were given to the trainees. The measures were pilot tested with 20 matched pre and posttest for final year anesthesia students.
Knowledge and attitude questions were examined for evidence change and response variation respectively. One question was dropped from the pilot measure (inappropriate material given the case) and one was reworded which led to the final version of the pretest. This pretest was completed on the first day of the training prior to any didactics or simulation scenario. At the end of the 3rd day workshop after the final scenario, the posttest was completed. All data were anonymous but coded with unique ID numbers to allow for comparing individual changes in scores. All participants of the training were included in this study.
Quantitative statistical analysis was performed using SPSS (version 20). All tests were 2-tailed, with significance set at P = 0.05. Paired t-test was used to determine difference between pretest and posttest self-efficacy for participants. The research question of this study is ‘do simulation-based trainings have an effect on non-physician anesthetists?
The knowledge assessment was a 9 test items tool to measure the knowledge retention after the simulation-based training. Question format was multiple choice questions (MCQ) which were prepared by the subject matter specialists in Mekelle University anesthesia department. Knowledge items analysis was conducted with the following parameters: a) item difficulty and b) discrimination coefficient. P -value between 0.2 -0.9 were considered acceptable and point biserial correlation coefficient value greater than 0.2 was considered acceptable for this study respectively. The attitude assessment items consist of 9 test items each scored on a 5- point Likert scale from ‘strongly agree’ to ‘strongly disagree’. All items were critically evaluated by subject matter specialists in anesthesia department.