Limitations of the study
RECRUITMENT
Due to the unforeseen circumstances posed by COVID-19 we were forced to halt trial recruitment and decided to perform an unplanned interim analysis of the results. We put in place a plan for a single interim analysis with a symmetrical stopping rule for a p< 0.002 using the Pocock rule. When we identified a p = 0.0039 for our primary outcome in the direction of improved outcomes for the normal group we decided to stop the trial based on futility. While the number of participants in our study was smaller than planned, the magnitude of the estimated effect sizes was consistently small. Furthermore, the group trained on the difficult scenarios were as likely to show worse results as they were to show improved results. For these two reasons we postulate that the inclusion of more participants would not change the primary outcome.Some participants in both groups had already used the ORSIMIn our study, we only assessed the level 2 of Kirkpatrick’s model of training evaluation: the testing of skills based on training [