[CHALLENGES IN LEARNING AND ASSESSING ANESTHESIA COGNITIVE AND NON-TECHNICAL SKILLS OF ANESTHESIOLOGISTS AND...

There are major challenges in teaching and assessing skills expected from practicing anesthesiologists and residents in anesthesia training programs. It is important to measure two separate aspects of skilled performance in managing crises: implementing appropriate technical actions (technical performance), manifesting appropriate crisis solving, and management of anesthesia non-technical behaviors. Anesthesia nontechnical skills (ANTS) can be divided into two subgroups: (1) cognitive or mental skills (decision-making, planning, strategy, risk assessment, situation awareness); and (2) social or interpersonal affective skills (teamwork, communication, leadership). Competency assessment of nontechnical (i.e. cognitive and affective) and technical (i.e. psychomotor) skills, is extremely hard to accomplish using only traditional examinations. The Accreditation Council for Graduate Medical Education (ACGME) has instituted an initiative that requires training programs to assess each resident's competence in several domains of medical practice. The ACGME toolbox for evaluation lists simulation training as the most effective evaluation strategy for medical procedures. Simulation scripts or scenarios can and should be aimed to evaluate and assess the technical and non-technical capabilities of residents in anesthesia. Lapsed or deficient non-technical (cognitive) skills, can easily lead to cognitive errors in anesthesia. Understanding and correcting cognitive errors cannot be overemphasized. Cognitive errors are thought-process errors which lead to incorrect diagnoses and/or treatments. To achieve error-free levels, learning objectives and curriculum/teaching should be adjusted to address the deficiencies identified in these learning skills. To reach this aim, educational training in cognitive errors, meta-cognition, and de-biasing strategies is needed. However, there are still many questions regarding which errors are most important to address and which "adjustment" learning strategies are the most appropriate and effective in anesthesiology. Sharing scenarios can provide an objective comparative view of trainees in different residencies, and the potential for universal applicability of such scenarios, and learning from the mistakes detected. Communication and collaboration among centers involved in simulation programs (including sharing of validated scenarios) is important to the future of this technology and approach. In summary, cognitive and non-cognitive simulation-based skills assessment that included the so-called ANTS can help to identify areas of strength and weakness that can be used to guide the residency curriculum, especially regarding deficiencies in tasks requiring higher order processing. Any such deficiencies need to be addressed in any training program.