Author: Jordan Francke, MD, MPH
IARS and SOCCA 2026 Annual Meeting coverage
High-fidelity simulation can reveal how anesthesiologists respond to rare perioperative emergencies and identify performance gaps that may not be detected through traditional written examinations. At the 2026 IARS and SOCCA Annual Meeting, medical education experts reviewed two major simulation studies examining crisis management, clinical reasoning, communication, and readiness for independent practice.
Matthew Weinger, MD, introduced the Simulation Assessment Research Group, a national consortium involving 12 institutions, the American Board of Anesthesiology, and private industry. The group focuses on using simulation to evaluate clinical performance.
The first study, MOCA Sim, assessed board-certified anesthesiologists during 20-minute simulations involving one of four perioperative emergencies. Common performance deficiencies included:
- Failure to call for assistance
- Inadequate communication with the surgeon
- Failure to escalate treatment appropriately
- Delayed defibrillation of unstable arrhythmias
- Failure to use emergency checklists or cognitive aids
These findings suggested that weaknesses during crises may involve communication, teamwork, and treatment escalation rather than a lack of basic medical knowledge.
William McIvor, MD, FASA, discussed the Improving Medical Performance During Acute Crises Through Simulation study, known as IMPACTS. The study compared junior, experienced, and senior anesthesiologists and examined whether simulation performance correlated with American Board of Anesthesiology examination results.
Participants completed crisis scenarios followed by 40-minute cognitive interviews. Their performances were evaluated by five independently trained video reviewers who were blinded to the participants’ backgrounds.
Senior anesthesiologists achieved the highest simulation scores, while junior anesthesiologists had the lowest. Previous simulation experience did not significantly improve performance, and there was no meaningful difference between anesthesiologists practicing in academic institutions and those working in community settings.
Simulation performance correlated strongly with results from the ABA Standardized Oral Examination but not with written examination scores. This suggests that oral examinations may more accurately assess clinical reasoning, communication, and real-time decision-making than knowledge-based written tests.
Michael H. Andreae, MD, PhD, discussed cognitive task analysis as a method for understanding why clinicians make specific decisions during emergencies. Immediately after each simulation, participants were interviewed about the cues they noticed, the goals they established, the actions they selected, and their reasons for those choices.
Across 102 anesthesiologists, four participating sites, and 408 interviews, high-performing clinicians demonstrated several distinguishing characteristics:
- Earlier recognition of a developing crisis
- More specific anticipation of potential complications
- Better-defined management goals
- More frequent checks confirming that treatments had worked
- Greater ability to adjust the plan as the situation evolved
Both high- and low-performing anesthesiologists often initially used temporary stabilizing measures before addressing the underlying cause. The major difference was that stronger performers recognized the crisis earlier and more consistently verified the effectiveness of their interventions.
Laurence Torsher, MD, highlighted the concerning finding that approximately 25% of board-certified anesthesiologists performed poorly during the simulated emergencies.
However, poor simulation performance may not necessarily mean that these physicians provide unsafe everyday care. Many simulation scenarios involve emergencies that an anesthesiologist may rarely or never encounter during an entire career. Performance problems were also frequently related to communication, teamwork, and delayed escalation rather than deficient medical knowledge.
Dr. Torsher proposed that anesthesiology education should emphasize excellent management of common clinical problems while preparing clinicians to use checklists, cognitive aids, artificial intelligence, and other decision-support technologies during rare, life-threatening events.
Key Takeaways
Written examinations alone may not adequately measure readiness for independent anesthesiology practice. High-fidelity simulation provides additional information about crisis recognition, communication, teamwork, treatment escalation, and clinical judgment.
Simulation performance appears to correlate more closely with oral board examination results than with written examination scores.
Experience matters, as senior anesthesiologists generally outperformed junior physicians. However, previous exposure to simulation alone did not guarantee stronger performance.
High performers recognize danger earlier, anticipate complications more specifically, and repeatedly confirm whether their interventions are working.
Residency training should combine strong preparation for common clinical care with structured practice in communication, crisis management, emergency checklist use, and escalation of treatment.
Artificial intelligence and cognitive aids may eventually help anesthesiologists manage rare emergencies, but these technologies should support rather than replace sound clinical judgment, teamwork, and decisive action.
Thank you to IARS and SOCCA for allowing us to summarize this important coverage from the 2026 Annual Meeting.