Identifying situation awareness training needs in anesthesia residents: a qualitative study

Introduction: Loss of situational awareness (SA) accounts for 82% of incidents due to human error in anesthesia. Despite its importance, SA training has traditionally been informal and inconsistent. Integrating SA into residency training is essential to enhance resident performance. Objective: This pilot study aimed to identify SA training needs for anesthesia residents. Methods: A three-level training needs analysis was conducted: 1. Organizational level: focus groups with faculty members were held to identify critical competencies. 2. Task level: five surgical procedures were observed using eye-tracking glasses to detect observable undesired events (OUEs). 3. Personal level: Interviews with residents and faculty were conducted to analyze the causes of OUEs and learning gaps. Results: A total of 17 training needs were identified. First-year residents require skill development in perception and comprehension, second-year residents need to improve attentional skills, and third-year residents should focus on projection skills. Conclusions: This qualitative observational study enabled the identification of gaps in SA training among anesthesiology residents. A total of 17 specific training needs were identified, which can be implemented in SA training programs for anesthesiology across various institutions. To ensure continuous evaluation and adaptation, it is recommended that these programs be progressively developed through high-fidelity clinical simulations, utilizing tools such as eye-tracking glasses.