Board 113 - Program Innovations Abstract Internal Medicine Resident Code Team Leadership Training Using Multimedia Support and High Fidelity Simulation (Submission #406)

Abstract

Introduction/Background Resident work hour limitations and the evolution of safety and quality improvement (QI) initiatives have resulted in fewer opportunities for trainees to participate in code blue events. One study showed a 41% reduction in hospital codes between 2002 and 2008, with an annual decrease of 13% after QI implementation. In 2008, these medical residents experienced 5 codes/year, compared to 29 in 2002.1 ACLS training is a common method used to prepare residents to manage codes. A survey of Canadian medicine residents at 13 schools showed that 49% lacked confidence to lead a code. Of those, 50.9% noted that ACLS did not address leadership and 40% received no training beyond ACLS. Respondents requested high fidelity simulation (HFS), leadership training and post-event debriefing/feedback to improve skills.2 Simulation improves compliance with ACLS guidelines. Second year medical residents completing a simulator-based ACLS training program had higher adherence to standards (correct responses 68%, SD 20%) compared to third year residents who completed a traditional ACLS course (correct responses 44%, SD 20%; p = 0.001).3 To address similar deficiencies, UC Davis Medical Center has implemented an innovative online and simulation-based curriculum to train medical residents in Code Team leadership. Methods The UC Davis SmartSite learning management system was used to create an online training course that teaches the fundamentals of code blue leadership. Internal Medicine interns are expected to complete the module near the end of their intern year (before carrying the code pager as a resident). The course offers a comprehensive review of the responsibilities associated with responding to codes. Course modules in Code Leadership, Basic Airway Management, Code Pharmacology and Cardiocerebral Resuscitation are comprised of seven-ten minute online lectures supported with audio overlay and video clips. Successful completion of the online portion of the module is measured using randomly generated 10-question timed pre and post-tests. A post-test score of 80% is required to pass. Proficiency is then evaluated in the simulation lab. Task trainers are used to demonstrate basic airway management and CPR. Direct guidance ensures proper technique. Leadership is assessed with a code blue event scenario using an HFS manikin and multiple confederates. Performance is scored using a standardized checklist. Immediate debriefing and feedback is provided. Residents are then required to complete a refresher session during the first week of their Medical ICU rotation. A repeat scoring checklist is obtained at that time. We report initial results from the pilot program, conducted in the Spring of 2013. Twenty-eight of twenty-nine (97%) medicine interns have completed the online training. Average pre-test score was 60%, 95% CI (52-68%, range 0-80%). Average post-test score was 89%, 95% CI (85-93%, range 60-100%). Three interns will need to retest due to a failing score. For the simulation training, the task training portion was tracked in seven categories and measured on a scale of one-three, with three showing proficiency. Interns mostly demonstrated proficiency in these basic resuscitation skills. The leadership assessment was a binary measurement (yes/no) for 27 critical actions. Comments were tracked. Interns were noted to be less proficient in demonstrating these critical actions. Refresher sessions to date have shown improvement but data analysis is forthcoming to determine the overall effect of the course. Conclusion We feel that this course is an innovative approach to code blue leadership training. Initial results indicate that the online course is successful; further analysis is necessary to determine the effect of the simulation session. We intend to compare senior medicine residents (who have not completed the online portion of the course) to determine the effect of the educational intervention. Overall, this program has been well received by the Internal Medicine residents. We intend to involve other specialties as time and scheduling permits.