Simuler 1 fois par an: Suffisant ?

Complex procedural skills are retained for a minimum of 1 yr after a single high-fidelity simulation training session

Boet S.et All. Br. J. Anaesth. (2011) 107 (4): 533-539

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Certaines procédures de mise en condition de survie sont rarement réalisées en conditions réelles. Pourtant leur maîtrise par le personnel qui intervient doit être acquise. Se pose dès lors le problème de l'acquisition et du maintien de ces compétences techniques. la simulation est un moyen d'y parvenir.  La coniotomie fait partie des ces gestes. Récemment il a été mis en avant que 5 réalisations simulées par des professionnels de l'urgence permettaient d'obtenir une relative maîtrise techniqe mais que cette dernière ne se maintenait pas au delà de  6 mois. (1). Le travail présenté confirme ces données.

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Background. Simulation has been shown to be effective in teaching complex emergency procedural skills. However, the retention of these skills for a period of up to 1 yr has not been studied. We aimed to investigate the 6 month and 1 yr retention of the complex procedural skill of cricothyroidotomy in attending anaesthetists using a high-fidelitysimulated cannot intubate, cannot ventilate (CICV) scenario.

Methods. Thirty-eight attending anaesthetists participated individually in a high-fidelitysimulated CICV scenario (pretest) that required a cricothyroidotomy for definitive airway management. Immediately after a debriefing and structured teaching session on cricothyroidotomy insertion, subjects managed a second identical CICV scenario (posttest). Each anaesthetist was randomized to either a ‘6 month retention’ or a ‘12 month retention’ group. No further teaching occurred. At their respective retention times, each anaesthetist managed a third identical CICV scenario (retention post-test). Two blinded experts independently rated videos of all performances in a random order, using a specific checklist (CL) score, a global-rating scale (GRS) score, and procedural time (PT).

Results. Subjects from both groups improved on their cricothyroidotomy skill performances from pretest to immediate post-test and from pretest to retention post-test, irrespective of the retention interval; CL mean (SD) 8.00 (2.39) vs 8.88 (1.53), P¼0.49; GRS 28.00 (7.80) vs 31.25 (5.31), P¼0.25; PT 102.83 (63.81) s vs 106.88 (36.68) s, P¼0.73.

Conclusions. After a single simulation training session, improvements in cricothyroidotomy skills are retained for at least 1 yr. These findings suggest that high-fidelity simulation training, along with practice and feedback, can be used to maintain complex procedural skills for at least 1 yr