Clinical Performance and Multitasking in Anesthesia : a Simulation-based Study (FOCUS)

Cognitive failure under multitasking conditions has been demonstrated in various settings, including healthcare. However, in anesthesiology, the impact of multitasking on clinical performance has not yet been fully characterized.

The objective of our study is to evaluate the impact of multitasking on anesthesiologists' clinical performance in a simulated setting.

Study Overview

• Status: Recruiting
• Conditions: Anesthesia; Simulation Training; Clinical Reasoning; Clinical Performance; Simulation Based Medical Education; Multitasking Behavior and Multitasking Ability
• Intervention / Treatment: Other: Multitasking

Detailed Description

This study is a prospective, single-center, non-interventional study. The study was classified as non-interventional by the institutional research committee, as the intervention consists of simulation training and the study population comprises healthcare practitioners.

The study participants are anesthesiologists, including attending physicians and residents. Each participant will serve as their own control. The study will comprise two visits: one intervention visit consisting of a multitasking simulation session, and one control visit involving clinical questions administered under quiet conditions. The order of the visits will be randomized between participants using a crossover design in order to minimize potential learning bias.

The multitasking condition will consist of performing manual mask ventilation on a manikin while answering oral clinical questions administered in the form of Script Concordance Tests (SCTs). Participants will be instructed to ventilate the manikin with a tidal volume of 500 mL and a respiratory rate of 15 breaths/minute.

Clinical reasoning under quiet conditions will consist of answering oral clinical questions in the SCT format.

The study will use a 44-item Script Concordance Test (SCT) distributed across 20 anesthesiology clinical vignettes. The vignettes are distributed as follows: 8 vignettes with 3 items, 8 vignettes with 2 items, and 4 vignettes with 1 item. The vignettes were adapted, without modification of their content, to be compatible with oral administration and the simulation scenario.

In addition, for each participant, the SCT clinical vignettes will be randomized between the "simulation vignettes" and the "control vignettes," with stratification according to the number of items per vignette. Five vignettes will be allocated to the intervention condition and fifteen to the control condition. This approach will help limit the effect of differences in vignette difficulty that could otherwise bias the results. At the group level, all clinical vignettes will ultimately be assessed in both the simulation and control conditions.

Detailed information is available in the study protocol.

• Study Type: Observational
• Enrollment (Estimated): 35

Contacts and Locations

• Study Contact: Name: Jean-Noël Evain, MD, PhD; Phone Number: +33476766829; Email: jnevain@chu-grenoble.fr
• Study Contact Backup: Name: Caroline Sanchez, PhD; Phone Number: 0476766829; Email: csanchez5@chu-grenoble.fr

Study Locations

• France
  • Grenoble, France, 38700
    • Recruiting
    • Centre d'Évaluation et de Simulation Alpes Recherche (CESAR)
    • Contact: Jean-Noël Evain, MD, PhD; Phone Number: 0476766829; Email: jnevain@chu-grenoble.fr
    • Contact: Alexis Lesage, MD; Phone Number: 0476766829; Email: ALesage@chu-grenoble.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of a sample of anesthesiology and intensive care physicians working at Grenoble University Hospital.

Description

Inclusion Criteria:

• Anesthesiology and intensive care resident or attending physician
• Written informed consent

Exclusion Criteria:

• None

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Concordance score with the expert panel on a Script Concordance Test (SCT)	Each item of the SCT is scored out of 1 point, and the sum of the points, converted to a 100-point scale, defines the percentage of concordance with the expert panel.	At two time points: - During simulation session under multitasking conditions - During control visit under quiet conditions

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to answer items of the script concordance test (seconds)	Time between end of question and beggining of answer for each item of the script concordance test. Evaluates the interruption lag.	Two time points: intervention and control.
Manual ventilation performance assessed by variance of expiratory tidal volume (ml)	Participants will be instructed to ventilate with an expiratory tidal volume (Vte) between 450 and 500 mL at a respiratory rate of 15 breaths per minute. Variability in Vte will be used as an indicator of the difficulty in complying with these instructions.	- Training before simulation: baseline - During simulation: ventilation only, ventilation plus clinical questions
Manual ventilation performance assessed by variance of respiratory rate (cycles/minute)	Participants will be instructed to ventilate with an expiratory tidal volume (Vte) between 450 and 500 mL at a respiratory rate of 15 breaths per minute. Variability in respiratory rate will be used as an indicator of the difficulty in complying with these instructions.	- Training before simulation: baseline - During simulation: ventilation only, ventilation plus clinical questions
Cognitive load assessed by the NASA-TLX index (score out of 100)	The Official NASA Task Load Index (TLX) is a subjective workload assessment tool. By incorporating a multi-dimensional rating procedure, NASA TLX derives an overall workload score based on a weighted average of ratings on six subscales: mental demand, physical demand, temporal demand, performance, effort, frustration.	A two time points: - Evaluating cognitive load of manual ventilation alone, before simulation after training. - Evaluation cognitive load of multitasking, at the end of the simulation session

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exploratory sub-group analysis of the primary outcome measure	Subgroups: Clinical experience in anesthesiology < or >= 5 semesters; Left handed or right handed; Musical practice < or >= 5 years; Need for cognition scale (18 questions): < or >= median of the group score	Two time points: intervention and control.
Exploratory subgroup analyses of expiratory tidal volume variance and respiratory rate variance	Subgroups: Clinical experience in anesthesiology < or >= 5 semesters; Left handed or right handed; Musical practice < or >= 5 years; Need for cognition scale (18 questions): < or >= median of the group score	- Training before simulation: baseline - During simulation: ventilation only, ventilation plus clinical questions
Descriptive analysis of ventilation parameters	Inspiratory tidal volume (ml); Expiratory tidal volume (ml); Respiratory rate (cycles/minute); Resumption lag: time required to re-establish stable ventilation following interruption (seconds)	Training phase (baseline), simulation phase (ventilation-only and ventilation plus clinical questions)

Collaborators and Investigators

• Sponsor: University Hospital, Grenoble

Publications and helpful links

General Publications

• Westbrook JI, Woods A, Rob MI, Dunsmuir WT, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med. 2010 Apr 26;170(8):683-90. doi: 10.1001/archinternmed.2010.65.
• Sujka JA, Safcsak K, Bhullar IS, Havron WS 3rd. Simulation-Based Testing of Pager Interruptions During Laparoscopic Cholecystectomy. J Surg Educ. 2018 Sep-Oct;75(5):1351-1356. doi: 10.1016/j.jsurg.2018.01.012. Epub 2018 Feb 1.
• Murji A, Luketic L, Sobel ML, Kulasegaram KM, Leyland N, Posner G. Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety. Surg Endosc. 2016 Oct;30(10):4499-504. doi: 10.1007/s00464-016-4782-4. Epub 2016 Feb 19.
• McCurdie T, Sanderson P, Aitken LM. Traditions of research into interruptions in healthcare: A conceptual review. Int J Nurs Stud. 2017 Jan;66:23-36. doi: 10.1016/j.ijnurstu.2016.11.005. Epub 2016 Nov 10.
• Adams TN, Rho JC. Multitasking simulation: Present application and future directions. Med Teach. 2017 Feb;39(2):120-122. doi: 10.1080/0142159X.2016.1230666. Epub 2016 Sep 15.
• Jackson KM, Shaw TH, Helton WS. Evaluating the dual-task decrement within a simulated environment: Word recall and visual search. Appl Ergon. 2023 Jan;106:103861. doi: 10.1016/j.apergo.2022.103861. Epub 2022 Aug 20.
• Gui JL, Nemergut EC, Forkin KT. Distraction in the operating room: A narrative review of environmental and self-initiated distractions and their effect on anesthesia providers. J Clin Anesth. 2021 Feb;68:110110. doi: 10.1016/j.jclinane.2020.110110. Epub 2020 Oct 16.

Study record dates

Study Major Dates

• Study Start (Actual): June 9, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: May 22, 2026
• First Submitted That Met QC Criteria: May 22, 2026
• First Posted (Actual): May 29, 2026

Study Record Updates

• Last Update Posted (Actual): July 2, 2026
• Last Update Submitted That Met QC Criteria: June 30, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavior; Multitasking Behavior
• Other Study ID Numbers: RNIPH-2026-CESAR-FOCUS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Single center study

Drug and device information, study documents

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