From Examination to Education: Implementing Simulation-Based Training in Israeli Anaesthesia Residency Programmes  

Introduction 

Implementing simulation-based education and training (SBET) in residency programmes is not merely an act of goodwill. It requires coordinated engagement from multiple stakeholders, strategic planning, and, like any large-scale educational reform, a measure of favourable timing. Our recent national experience offers a practical roadmap for other professional societies considering similar initiatives. 

In Israel, SBET has been used for many years primarily during the final anaesthesia residency examinations, where it assesses residents’ ability to recognise and manage emergency situations.¹ These high-stakes simulations evaluated clinical reasoning, teamwork, and role delegation under pressure. 

Despite this extensive and pioneering use of SBET in examinations, simulation was not systematically integrated into routine training or patient safety programmes for Israeli anaesthesia residents. A general recommendation existed to complete three simulations during residency, either locally or at national conferences, but without guidance regarding timing, content, or participation tracking. 

As a result, anaesthesia training varied widely between departments. Some centres conducted more than 20 simulations throughout residency, while others, particularly smaller, peripheral hospitals, offered none. 

Catalyst for Change 

Following the 2023 Utstein Meeting in Copenhagen², which focused on implementing SBET in anaesthesia training and was led by Dr Doris Østergaard (then Chair of the ESAIC Simulation Committee) and further championed by Prof. Crina Burlacu (current Chair), a national effort was initiated to formally integrate SBET into Israeli anaesthesia residency training. 

Key Stakeholders 

In Israel, three main stakeholders must be aligned for such a reform to succeed: 

• The Scientific Council, responsible for defining the residency syllabus and accrediting training departments 
• Hospital management, which funds departmental educational activities and approves the allocation of resources 
• Department chairs of anaesthesia, who assign staff, time, and physical space for simulation activities 

Following a vote by the Israeli Society of Anaesthesiologists (ISA) Steering Committee, a dedicated Simulation Subcommittee was established. This committee included national leaders in anaesthesia simulation and education and was tasked with designing a feasible and sustainable SBET model tailored to the Israeli healthcare system. 

Needs Assessment and Framework Development 

The subcommittee conducted: 

• A national survey of anaesthesia departments 
• A review of international literature 
• Consultations with education leaders from all Israeli anaesthesia training centres 

From this process, four critical domains were identified: 

1. Training location 
2. Equipment and associated costs 
3. Instructor qualifications 
4. Evaluation and tracking methods 

The resulting recommendations were designed to balance educational rigour with practical feasibility. 

Core Recommendations 

The SBET framework was built around the following key principles: 

Curricular Integration 

SBET will be formally incorporated into the anaesthesia residency syllabus, with: 

• Three mandatory simulations per year 
• Fifteen mandatory simulations throughout residency 
• Ten additional optional simulations 

Department Accreditation 

A new accreditation criterion was added, requiring all anaesthesia departments to have personal or fully accessible simulation equipment to maintain residency program validation. 

On-Site Training 

Simulation training will be conducted: 

• On-site, within departmental facilities and operating theatres 
• By internal trainers 
• At times, it is determined by department chairs to optimise workforce management. 

Tracking 

Departmental education leads are responsible for tracking each resident’s participation throughout their residency. 

Instructor Training 

The ISA will establish a Train the Trainer (TTT) course, developed in collaboration with: 

• The ESAIC Simulation Committee 
• The Teach the Teacher Committee 

This programme will ensure credentialled simulation instructors are available in every department. 

Central Oversight 

The ISA Simulation Subcommittee will: 

• Develop and standardise all SBET scenarios. 
• Provide instructional guidance aligned with the residency syllabus. 

Implementation Date 

Implementation will begin in January 2026. 

Implementation and Faculty Development 

To support implementation, the ISA Simulation Subcommittee developed an SBET syllabus workshop based on the Utstein Meeting recommendations. 

A national TTT course was conducted in September 2025, involving 21 participants from all Israeli anaesthesia departments. The course focused specifically on developing pre-briefing and debriefing skills using simulation-based methodologies. 

Ongoing Support and Quality Assurance 

The final implementation phase focuses on follow-up and continuous guidance. The ISA Simulation Subcommittee, together with Israeli TTT facilitators, will: 

• Conduct four national meetings per year. 
• Address interpretation pitfalls and key learning points related to that year’s mandated simulation scenarios. 
• Facilitate open discussion and peer support for newly trained simulation instructors. 

These meetings will complement the intensive two-day TTT course and promote consistency nationwide. 

Strategic Alignment and Impact 

Importantly, both the revised anaesthesia residency syllabus and the updated department accreditation criteria were submitted for final approval in the same year. This alignment allowed close collaboration with other subcommittees and strengthened institutional support. 

This coordinated approach is expected to encourage hospital management to invest in educational infrastructure and adopt modern faculty development tools. 

Conclusion 

Beginning in January 2026, Israel’s anaesthesia residency program will embed SBET as a core curricular component. Through collaboration between the Scientific Council, hospital administrations, and departmental leadership—and guided by ESAIC recommendations—this initiative ensures structured, nationwide access to simulation training. 

SBET is thus transformed from a tool used primarily for examination into a foundational element of safer, more consistent, and higher-quality clinical education. 

Author:

• Yitzhak Brzezinski Sinai
• Rony Hakim
• Barak Cohen

References

1. Berkenstadt H, Ziv A, Ezri T, Rubin O, Sidi A. Formative Role of Simulation-Based Objective Structured Clinical Examination (OSCE) National Board Examination in Anesthesiology. Simulation in Healthcare. 2007;2(1):57. 
2. Savoldelli GL, Burlacu CL, Lazarovici M, Matos FM, Østergaard D, Utstein Simulation Study Group. Integration of simulation-based education in anaesthesiology specialist training: Synthesis of results from an Utstein Meeting. European Journal of Anaesthesiology. 2024;41(1):43–54.