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

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.

Study Overview

• Status: Completed
• Conditions: To Determine the Change in Demonstrated Anesthesia Non-technical Skills After Delivery of the VAST Course
• Intervention / Treatment: Other: VAST Course

• Study Type: Interventional
• Enrollment (Actual): 32
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Rwanda
  • Butare, Rwanda
    • University of Rwanda
  • Kigali, Rwanda
    • Rwanda Military Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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.)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: VAST Course	Other: VAST Course; Educational course to teach non-technical skills

What is the study measuring?

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)

Collaborators and Investigators

• Sponsor: Dalhousie University

Study record dates

Study Major Dates

• Study Start (Actual): August 24, 2018
• Primary Completion (Actual): January 30, 2019
• Study Completion (Actual): June 30, 2019

Study Registration Dates

• First Submitted: August 19, 2019
• First Submitted That Met QC Criteria: August 18, 2020
• First Posted (Actual): August 20, 2020

Study Record Updates

• Last Update Posted (Actual): August 21, 2020
• Last Update Submitted That Met QC Criteria: August 19, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Other Study ID Numbers: 2018-4474

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No