Proximity to primary board certification and prior crisis management experience are associated with anesthesiologists' performance in high-fidelity acute care scenarios.

Introduction: Consistent high-level performance during perioperative critical events is essential for achieving optimal patient outcomes. We sought to better understand factors associated with anesthesiologists' performance during simulated crisis management. Methods: Sixty clinically active board-certified anesthesiologists (BCAs), 22 junior (6 to 18 mo. training) and 19 senior (24 to 48 mo.) anesthesia trainees participated in standardized, high-fidelity simulated out-of-OR crisis events. Participants completed demographic and practice attributes surveys, and then performed four different 15-minute scenarios. Trained, board-certified raters scored randomly assigned video-recorded performances using checklists and holistic scaled ratings. A principal component analysis summarized survey responses related to participants' clinical, simulation, and crisis management experience. Mixed-effects regression was used to examine the relationship of performance ratings to the summarized variables, adjusting for participant attributes, study site, and scenario. Results: The participants were 55% male, 38±8 years old and had 8.8±6.7 years of experience (training included). The BCAs were 67% community practitioners. Generally, senior trainees received the highest scores while junior trainees received the lowest. There was a strong association between overall performance and combined years of training and experience (p = 0.008). Experience with prior crises (p=0.040), but not clinical practice attributes (p=0.97) or prior simulation experience (p=0.94), was associated with higher rated performance. High-performing participants were more likely to call for assistance, physically examine the patient, order additional diagnostic tests, escalate therapy (e.g., greater hemodynamic support or antibiotic coverage), broaden the differential, discuss concerns with a colleague, and provide both temporizing and definitive treatment. Discussion: This simulation-based study found differences in performance ratings on perioperative crisis events based on experience and prior exposure to challenging clinical situations. These findings corroborate prior work, validate the use of simulation for assessment, and reinforce the value of ongoing crisis management exposure and training to improve patient care.