# The evolution of self and hetero-evaluation of repeated high fidelity simulation scenarios of post-partum hemorrhage with anesthesia trainees

## TL;DR

Anesthesia trainees improved their self-assessment accuracy after repeated high-fidelity simulations of postpartum hemorrhage scenarios.

## Contribution

This study shows how repeated simulation training reduces overestimation of performance in anesthesia trainees.

## Key findings

- Trainees' behavioral scores improved progressively across four simulation scenarios.
- Self and team assessments were higher than expert evaluations in early scenarios but aligned later.
- Overestimation of performance decreased after the first two simulation rounds.

## Abstract

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Introduction

Evidence for self-assessment in medicine is controversialwith participants under-rating or overestimating their performance. It is also unclear whether this under or overestimation changes during the process of repeated simulation experience. In this study, the authors analyzed the evolution of the behavioral skills of anesthesia trainees during four consecutive standardized postpartum hemorrhages (PPH) high-fidelity simulation scenarios. They compared the self-assessment made by the leader himself and the assessment made by his teammates individually with the assessment made by two expert observers.

Methods

The authors enrolled forty anesthesia trainee volunteers and divided them into eight teams of five participants each. Each team enacted the same scenario of a patient with atonic PPH following vaginal delivery four times so that all the trainees, except the one assigned the leader’s role, could rotate through the roles of anesthesia trainee, obstetrician, midwife, and nurse. The participants themselves and two expert observers, using standardized checklists and questionnaires, carried out an evaluation of the technical (diagnosis and treatment of atonic PPH) and behavioral (leadership, communication, situational awareness, and overall appraisal) skills evidenced in the scenarios.

Results

The authors noted a progressive improvement in the behavioral scores given to the leader by the examiners, his team, and himself, from the first to the fourth scenario. The scores given by the participants and by the leader himself were greater than those given by the independent observers in the first two scenarios but these differences were no longer significant during the last two scenarios.

Discussion

Participants overestimated their performances but this overestimation disappeared after the completion of the first two scenarios. The authors suggested that improving the skills of participants throughout the scenarios, most likely improved their metacognitive competence, helping them to better recognize their abilities.