HIGH FIDELITY SIMULATION TRAINING: DOES IT IMPROVE INTERNAL MEDICINE RESIDENT PHYSICIAN CONFIDENCE, KNOWLEDGE, AND SKILL PERFORMANCE REGARDING TRACHEOSTOMY?

Abstract

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Internal Medicine (IM) resident physicians lack confidence and knowledge on how to manage basic and emergent clinical situations involving tracheostomy. High fidelity simulation is an effective training medium to address such deficiencies but is under-researched and under-utilized. This prospective, quantitative pilot educational and quality improvement study sought to answer if high fidelity simulation training on tracheostomy improves IM resident knowledge, confidence, and team skill performance. METHODS: Over 4 months (January - April 2021), 31 post-graduate year (PGY) 2 and PGY3 IM residents at a large academic hospital participated in this study. Participants were scored on baseline skill performance as a team in a high fidelity simulation of desaturation in a tracheostomy patient using a validated checklist. Thereafter, participants underwent a 3 hour educational intervention comprised of lecture, skills stations, and several simulations of emergent tracheostomy clinical situations. Final team performance on the same simulation initially used to assess baseline performance was scored. Pre and post intervention confidence and knowledge were assessed and compared to PGY2 and PGY3 IM residents who did not take the course. RESULTS: 20 PGY2 IM residents underwent the course. Confidence (P<0.0001) and knowledge (P<0.0001) significantly improved from pre-intervention to post-intervention. Confidence for residents post-intervention was greater than for PGY2 and PGY3’s who did not take the course (P<0.0001). Knowledge for residents post-intervention was greater than for PGY2 and PGY3’s who did not take the course (P<0.0001). In general, team skill performance in simulation improved from pre-intervention to post-intervention, though findings are limited by power and are not statistically significant. CONCLUSIONS: Our study demonstrates PGY2 IM resident confidence and knowledge on basic and emergent tracheostomy clinical situations improves significantly following educational intervention with hands-on instruction and high fidelity simulation. Confidence and knowledge in PGY2 IM residents following the course was significantly greater than for PGY2 and PGY3 IM residents who did not take the course. Our study also suggests team skill performance may be improved by the intervention. CLINICAL IMPLICATIONS: This study demonstrates that high fidelity simulation is an effective method of teaching IM resident physicians the knowledge necessary to manage basic and emergent tracheostomy clinical situations and also improves confidence. Given that many patients with acute respiratory failure from COVID-19 and other causes are frequently treated with tracheostomy and cared for by IM residents, this intervention may improve clinical outcomes for patients with tracheostomies. DISCLOSURES: No relevant relationships by Paul Christos, source=Web Response No relevant relationships by Timothy Clapper, source=Web Response No relevant relationships by Kelly Crane, source=Web Response No relevant relationships by Kapil Rajwani, source=Web Response