Can we Make a VAST Improvement? Promoting Anaesthetists' Non-technical Skills Through the Vital Anaesthesia Simulation Training Course in a Low-resource Setting

Study Overview
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Brief Summary
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Rationale: The World Health Assembly resolution 68.15 identified surgical and anesthesia care as core components of universal health coverage. However, about 5 billion people worldwide lack access to essential surgical and anesthesia services. Of the 313 million procedures undertaken each year only 6% occur in the poorest countries with an estimated 30% of all deaths globally associated with common surgical conditions. Patient safety in low-resource settings is hindered by severe workforce shortages, lack of essential resources, hierarchical culture and few opportunities for professional development. Non-technical skills (NTS), such as communication, team working, and task coordination, are vital to patient safety. Up to 70-80% of untoward events in health care are associated with errors in NTS8. The Anaesthetists' Non-Technical Skills framework (ANTS) describes behaviour markers for NTS in anesthesia. This framework has been found applicable in low-resource settings. Simulation-based education is widespread for NTS training in well-resourced countries. Traditionally, high costs have prohibited this modality in low-resource settings. Foundational work in Rwanda and at Dalhousie University has demonstrated that effective training in ANTS can be achieved through simple low-cost simulation. The Vital Anaesthesia Simulation Training (VAST) Course is a three-day simulation-based program designed de-novo to focus on core clinical practices and NTS that promote safe perioperative care in low-resource settings. The course uses low-cost materials in an immersive simulated environment to replicate common cases managed in district hospitals in low-resource settings. Realism is created with simple mannequins, iPads with the SimMon App functioning as monitoring, basic props (e.g., airway equipment, syringes, drapes), photographs of pathology, and briefing cards for scenario role-play. Purpose: To assess the impact of the VAST Course on ANTS and explore factors that influence long-term retention of ANTS amongst anesthesia providers in a low-resource setting.

Official Title
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Can we Make a VAST Improvement? Promoting Anaesthetists' Non-technical Skills Through the Vital Anaesthesia Simulation Training Course in a Low-resource Setting

Conditions
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To Determine the Change in Demonstrated Anesthesia Non-technical Skills After Delivery of the VAST Course

Intervention / Treatment
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* Other: VAST Course


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All anesthesia (anesthesiologists, anesthesia residents and non-physician anesthetists) VAST Course participants during the study period. Exclusion Criteria: VAST Course participants who do not practice anesthesia (surgeons, nurses, midwives etc.)
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: VAST Course<br> | Other: VAST Course<br>* Educational course to teach non-technical skills<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Anesthesia NonTechnical Skills (ANTS) Score | Baseline ANTS Score | Day 1 (pre-course test) | 
| Total Anesthesia NonTechnical Skills (ANTS) Score | The change from baseline ANTS score to post-course (day 3) | Day 3 (post-course test) | 
| Total Anesthesia NonTechnical Skills (ANTS) Score | The change from baseline ANTS score to follow-up (4 months) | 4 months (follow-up score) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Category Anesthesia NonTechnical Skills (ANTS) Score | Baseline category ANTS scores (team working, task management, situation awareness, decision making) | Day 1 (pre-course) | 
| Category Anesthesia NonTechnical Skills (ANTS) Score | The change in category ANTS scores (team working, task management, situation awareness, decision making) | Day 3 (post-course) | 
| Category Anesthesia NonTechnical Skills (ANTS) Score | The change in category ANTS scores (team working, task management, situation awareness, decision making) | 4 months (post-course) |