Simulation has become an essential element in the learning and assessment of anesthesia trainees . It offers a controlled environment to explore various clinical entities and their impact on anesthesia management without the risk of harming an actual patient. Cardiac anesthesia seems to be an excellent field for simulation due to the complexity of cardiac pathophysiology. A systematic review with meta-analysis on simulation-based anesthesia training demonstrated that simulation training in anesthesia is at least as good as non-simulator training, and is much better than no intervention. 
Our aim was to evaluate the role of a high-fidelity cardiovascular simulation software on the anesthesia trainees' education and professional evolution.
We used a high-fidelity cardiovascular simulator, present at the University Hospitals Leuven, reproducing the main hemodynamic changes of the cardiovascular system . For this purpose, the simulator was uploaded to a server so users could access it remotely. The simulator was used in 4 consecutive simulation sessions, awarded only for the senior (4th- and 5th-year) anesthesia specialist trainees at the University Hospitals Leuven. Each session focused on a specific topic, namely cardiac tamponade, aortic valve, and mitral valve pathologies. The sessions were given online via zoom video communication due to Covid-19 social restrictions. The trainees initially received a short PowerPoint presentation regarding the topic, followed by hands-on training using the cardiovascular software accessible online. A short quiz was implemented at the beginning and end of the training session to assess the trainee's knowledge and progress. Furthermore, the trainees completed a satisfaction questionnaire at the end of the simulation course.
In total, 47 anesthesia trainees attended the online simulation sessions. The trainees were markedly pleased with the format of the simulation, combining the short theoretical overview with the hands-on simulation training. Besides, they reacted positively to the simulation cases and the explanations given by the instructors. Yet, there is still room for improvement to make the simulator better accessible from remote locations. All the trainees agreed that the simulator is a valuable tool in anesthesia training, and 78,7% of them stated that the simulator promotes a better understanding of cardiovascular pathophysiology and helps develop clinical reasoning.
The simulator has proven to improve knowledge of pathophysiology of the cardiac patient. The majority of trainees evaluated the simulation as a useful experience, a valuable tool for understanding the complex cardiac pathophysiology, with a good format and clear explanations by the instructors. The study has some limitation concerning sample size. To thoroughly study the effect of the use of the simulation on the trainees’ progress, the sample size should be larger and a comparison should be made between a simulation group and a control group.
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