Preparing the Next Generation of Independent Anesthesiologists: Lessons from a High-Fidelity Simulation Study

Jordan Francke, MD, MPH

A team of experts in medical education and assessment assembled to discuss the results of two of their studies during the session, “What Can a Large High-Fidelity Simulation Study of Acute Care Management Tell Us About Anesthesiologists and their Practice,” held on Friday, May 1, at the 2026 Annual Meeting, presented by IARS and SOCCA. Moderated by Matthew Weinger, MD, Norman Ty Smith chair in patient safety and medical simulation and professor of anesthesiology, biomedical informatics, and medical education at Vanderbilt University Medical Center, the session introduced the audience to the Simulation Assessment Research Group (SARG), a national multidisciplinary consortium of researchers and educators representing twelve institutions, the American Board of Anesthesiology, and private industry. SARG is primarily focused on simulated-based research, especially for performance assessment.

Dr. Weinger discussed the first study, “MOCA Sim,” evaluating the efficacy of board-certified anesthesiologists at completing 20-minute simulations of one of four perioperative emergencies. Frequent performance gaps included communication deficiencies (e.g., failing to call for help or engage with the surgeon), failure to escalate treatment sufficiently (e.g., failing to shock an unstable arrhythmia), and failure to use emergency checklists. He then introduced a newer study entitled Improving Medical Performance during Acute Crises Through Simulation (or IMPACTS).

The second panelist William McIvor, MD, FASA, professor at University of Pittsburgh. Dr. McIvor, described how IMPACTS aims to describe the relationship of simulation-based performance to ABA exam scores, and added junior and senior anesthesiologists compared to MOCA Sim. After each scenario, anesthesiologists conducted a 40-minute cognitive interview, and no feedback was provided until the end of the day. Performances were scored by five independently trained and blinded video raters. Results showed senior anesthesiologists had the highest scores, junior anesthesiologists had the lowest scores, and prior simulation experience did not influence performance. There was no difference between anesthesiologists practicing in the community setting compared to academic hospitals. Lastly, performance in simulations correlated strongly with performance on the ABA Standardized Oral Examination but not on the written exam.

The third panelist Michael H. Andreae, MD, PhD, professor of anesthesiology at University of Utah, discussed various methodologies to study clinical decision-making. One can easily study learners’ actions, what verbal orders they make, and the drug dosages they administer, but what can be much more challenging is evaluating logic and mental models (or more simply, the “why”). He discussed how cognitive task analysis can be a valuable tool, executing interviews immediately after a high-fidelity crisis scenario and asking a learner to reflect on what actions they performed and the motivations. This framework was employed with success across 102 anesthesiologists at four sites with 408 total interviews, and evaluated learners’ cues, goals, and actions. What they found was that high performers had earlier and more specific robust anticipation of crises and completed execution checks more frequently, but that both high and low performers temporized when faced with crises before targeting the underlying cause.

The panel concluded with a talk by Laurence Torsher, MD, associate professor of anesthesiology at Mayo Clinic. He found himself troubled by some findings from the IMPACTS study, including that 25% of board-certified anesthesiologists performed poorly in the simulated environment. Compared to the MOCA Sim study, the IMPACTS study had more board-certified anesthesiologists with time-limited board certification, noncompulsory simulation experience, and more varied options in terms of participation with MOCA 2.0. He thinks most colleagues would agree that patients are safer today in the OR setting than they were 15 years ago, but simulation performance results are not necessarily showing that physicians are stronger. He suggested two possible explanations: (1) many simulations are based on emergencies that occur rarely (if ever) during a physician’s career and thus are less relevant for most day-to-day practice, and (2) some subpar performances are more related to communication lapses or failures to escalate care rather than weaknesses in medical knowledge. He proposed that artificial intelligence and other emerging technologies may be the answer to this conundrum. Perhaps, as educators, we should be emphasizing strong management of bread-and-butter medicine that residents will encounter on a daily basis and improving communication, while utilizing AI-based technologies and checklists or other cognitive aides when encountering rarer but life-threatening emergencies. Future studies may elucidate the answers to these questions.