Anesthesiology 2008; 108:831– 40 Copyright © 2008, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Part Task and Variable Priority Training in First-year Anesthesia Resident Education A Combined Didactic and Simulation-based Approach to Improve Management of Adverse Airway and Respiratory Events Ken B. Johnson, M.D.,* Noah D. Syroid, M.S.,† Frank A. Drews, Ph.D.,‡ L. Lazarre Ogden, M.D.,§ David L. Strayer, Ph.D., Nathan L. Pace, M.D., M.Stat.,# Diane L. Tyler, M.S.,** Julia L. White, R.N.,†† Dwayne R. Westenskow, Ph.D.‡‡ Background: Part task training (PTT) focuses on dividing complex tasks into components followed by intensive concen- trated training on individual components. Variable priority training (VPT) focuses on optimal distribution of attention when performing multiple tasks simultaneously with the goal of flexible allocation of attention. This study explored how principles of PTT and VPT adapted to anesthesia training would improve first-year anesthesiology residents’ management of simulated adverse airway and respiratory events. The authors hypothesized that participants with PTT and VPT would per- form better than those with standard training. Methods: Twenty-two first-year anesthesia residents were randomly divided into two groups and trained over 12 months. The control group received standard didactic and simulation- based training. The experimental group received similar train- ing but with emphasis on PTT and VPT techniques. Participant ability to manage seven adverse airway and respiratory events were assessed before and after the training period. Perfor- mance was measured by the number of correct tasks, making a correct diagnosis, assessment of perceived workload, and an assessment of scenario comprehension. Results: Participants in both groups exhibited significant im- provement in all metrics after a year of training. Participants in the experimental group were able to complete more tasks and answered more comprehension questions correctly. There was no difference in perceived workload or the number of correct diagnoses between groups. Conclusion: This study in part confirmed the study hypothe- ses. The results suggest that VPT and PTT are promising ad- juncts to didactic and simulation-based training for manage- ment of adverse airway and respiratory events. PART task training (PTT) and variable priority training (VPT) are techniques that have been developed by psy- chologists to optimize human performance when com- pleting complex tasks. These techniques have been suc- cessfully implemented in a number of simulator-based professional training arenas and have led to higher pass rates in settings where students are asked to manage multiple tasks. 1 Part task training is defined as the decomposition of large multicomponent tasks into a set of component tasks that when trained as individual components either separately or in various combinations can become highly automatized. 2–4 This training reduces processing de- mands by streamlining effort associated with the individ- ual elements of the task. Focused training also leads to more rapid development of automatic skills that might otherwise not be achieved in the context of the whole task. Variable priority training is a method for training people to flexibly distribute attention over multiple as- pects of a task. Participants in VPT learn to coordinate and control how attention is allocated to components of a task and assign different processing priorities to the components as they are performed in concert. VPT fos- ters flexible cognitive style that reduces the likelihood of cognitive tunnel vision. 5 We have used PTT and VPT techniques as part of the didactic and simulation-based training for first-year anes- thesia residents (CA-1s) over a 12-month period. Train- ing was directed toward detection and appropriate treat- ment of adverse airway and respiratory events reported in the closed anesthesia malpractice claims database. 6–8 These events were made up of unrecognized esophageal intubations as a result of difficult intubations, 8 airway trauma, pneumothorax, airway obstruction, aspiration, and bronchospasm. 7 These adverse events occur with a higher frequency in pediatric patients with more severe consequences (e.g., higher rate of mortality or brain injury). 6 Airway management difficulties, impaired vigi- lance, inadequate supervision, poor judgment, diversion of attention, and misinterpretation and misuse of data were also noted as potential sources for bad outcomes associated with adverse airway and respiratory events. 6 The aim of this study was to demonstrate that PTT and VPT would improve CA-1 management of simulated ad- verse airway and respiratory events. Compared with CA-1s with conventional simulator training, we hypoth- esized that CA-1s with PTT- and VPT-oriented simulator training would (1) complete more critical tasks essential * Associate Professor and Director, † Technical Director, ** Education Direc- tor, Center for Human Simulation, Department of Anesthesiology, ‡ Assistant Professor,  Professor, Department of Psychology, § Associate Professor, # Pro- fessor, †† Research Coordinator, Department of Anesthesiology, ‡‡ Professor, Department of Biomedical Engineering, University of Utah. Received from the Department of Anesthesiology, University of Utah, Salt Lake City, Utah. Submitted for publication March 5, 2007. Accepted for publication January 10, 2008. Supported in part by a research grant from the Anesthesia Patient Safety Foundation, Indianapolis, Indiana, and the Learned Family En- dowed Associate Professorship, Department of Anesthesiology, University of Utah, Salt Lake City, Utah. Presented in part at the Annual Meeting of the American Society of Anesthesiologists, Chicago, Illinois, October 17, 2006, and the 5th Annual International Meeting on Medical Simulation, Miami, Florida, January 13–16, 2005. Address correspondence to Dr. Johnson: Center for Patient Simulation, De- partment of Anesthesiology, University of Utah, 30 North, 1900 East, Room 3C444, Salt Lake City, Utah 84132-2304. ken.b.johnson@hsc.utah.edu. Informa- tion on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. ANESTHESIOLOGY’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue. Anesthesiology, V 108, No 5, May 2008 831 Downloaded from anesthesiology.pubs.asahq.org by guest on 05/24/2020