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

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.

• Multitasking (Other): Simulation training session during which participants will be required to multitask by performing manual mask ventilation on a manikin while answering oral clinical questions administered in the form of Script Concordance Tests (SCTs).

Primary outcomes

• Concordance score with the expert panel on a Script Concordance Test (SCT) [At two time points: - During simulation session under multitasking conditions - During control visit under quiet conditions]: 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.

Secondary outcomes

• Manual ventilation performance assessed by variance of expiratory tidal volume (ml) [- Training before simulation: baseline - During simulation: ventilation only, ventilation plus clinical questions]: 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.
• Manual ventilation performance assessed by variance of respiratory rate (cycles/minute) [- Training before simulation: baseline - During simulation: ventilation only, ventilation plus clinical questions]: 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.
• Cognitive load assessed by the NASA-TLX index (score out of 100) [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]: 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.
• Time to answer items of the script concordance test (seconds) [Two time points: intervention and control.]: Time between end of question and beggining of answer for each item of the script concordance test. Evaluates the interruption lag.

Other outcomes

• Exploratory sub-group analysis of the primary outcome measure [Two time points: intervention and control.]: 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
• Exploratory subgroup analyses of expiratory tidal volume variance and respiratory rate variance [- Training before simulation: baseline - During simulation: ventilation only, ventilation plus clinical questions]: 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
• Descriptive analysis of ventilation parameters [Training phase (baseline), simulation phase (ventilation-only and ventilation plus clinical questions)]: * Inspiratory tidal volume (ml) * Expiratory tidal volume (ml) * Respiratory rate (cycles/minute) * Resumption lag: time required to re-establish stable ventilation following interruption (seconds)

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

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

Exclusion Criteria:

* None

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• Study Protocol and Statistical Analysis Plan (PDF, 2026-06-05)