A demographic questionnaire will be filled out by each participant. After randomization, participants will be presented with the background information of the simulated scenario.Subsequently:

• participants forethought will be prompted and each participant will be asked to report his/her forethought,
• participants then will be asked to manage a simulated massive transfusion scenario,
• at completion of the scenario, each participant will undergo individualized debriefing and a syllabus on massive transfusion will be briefly discussed with them and also provided as a reading material for learning.

A demographic questionnaire will be filled out by each participants. After randomization, participants will be presented with the background information of the simulated scenario.Subsequently:

• participants will sit and wait for a predetermined time before entering into the simulator,
• participants then will be asked to manage a simulated massive transfusion scenario,
• at completion of the scenario, each participant will be interviewed about their thought process before entering to the simulation room,
• each participant will undergo individualized debriefing and a syllabus on massive transfusion will be briefly discussed with them and also provided as a reading material for learning.

Participants will be asked questions which elicit specific forethought elements related to the given clinical situation. These are elements that relate to strategic planning, goal setting, goal orientation, imagery, outcome expectation. These context specific questions will be determined in the Pilot study and validated in Study I.

Task specific performance tool will be developed in the Pilot study and will be validated in Study I. Each performance will be video recorded and two independent, blinded rater will evaluate the videos and assess performance. Performance assessment tool will be numerical including a 1-5 point scale for each performance element and a Global Rating Scale. Difference between massive transfusion management performance will be compared in anesthesia residents whose forethought is prompted to residents who don't receive prompting.

The investigators will determine if quality of forethought relates to quality of performance in anesthesia residents managing the simulated massive transfusion scenario. The Pilot study and Study I will be used to develop and validate a scoring form for forethought. This will include scores (1-5) for each forethought elements (strategic planning, goal setting, goal orientation, imaginary, outcome expectation) and a GRS (1-5).

In the Pilot study, think-aloud protocol will be used to identify forethought elements in experts (attending anesthesiologists) and non-expert (anesthesia residents). The real-time interviews will be used to design the measurement tool for forethought and also to develop a tool for prompting forethought. Equally, performance in a simulated massive transfusion scenario in experts and non-experts will be used to develop a scoring format for performance. The provisional scoring format then will be reviewed by experts and the research group. Study I will determine construct and predictive validity and reproducibility (inter-rater reliability) of these measurement scores.