SIMULATION BASED TRAINING IMPROVING RESIDENT'S SKILL AND COMFORT IN CRITICAL SITUATIONS

Abstract

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Advanced Cardiac Life Support (ACLS)/Basic Life Support (BLS) has long been the standard of practice in the treatment of critically ill patients. Although certification courses exist, their limitations include truncated training time and a lack of inpatient scenarios, a commonly encountered obstacle faced by many physicians-in-training. The goal of this research is to identify a resident physicians’ comfort level during critical situations before and after participating in a high-fidelity simulation-based training exercise in an attempt to improve skills and efficiency in real-world situations. Secondary aims include developing a universal data gathering platform to audit the effectiveness of simulation-based training. Our hypothesis is that simulation-based training will improve a resident’s level of comfort and skill as a leader in critical situations. METHODS: Participants include internal medicine residents ranging from post graduate year (PGY) 1 to year 3. The simulation-based exercise will outline a critical situation scenario with the participant acting as the lead provider. Critical situations include scenarios outlined by ACLS (cardiac arrest, bradyarrhythmias, tachyarrhythmias, stroke, etc) and hospital specific rapid response scenarios. Prior to and after the training exercise, each resident completed a self-evaluation survey using the Likert Scale and a 10 question multiple choice quiz to assess skills knowledge. RESULTS: A total of 64 residents participated in the critical situation simulation-based training; 30 PGY-1 residents, 20 PGY-2 residents, and 14 PGY-3 residents. The average comfort level point difference for all residents after the exercise was +5.8. The largest increase in self-reported comfort level was seen in first year residents (+7.4) and those with no prior critical situation leader experience (+6.3). The skills quiz showed an increase of 12.9% or 1.2 more questions correct after completion of simulation-based training. Both the results of the survey and quiz questions revealed a statistically significant increase (p < 0.001). CONCLUSIONS: Results of our study found that participation in simulation-based training improved the level of comfort in critical situations especially amongst first-year residents and those with the least prior experience. While we are cognizant that self-assessment of comfort level does not directly translate to competence, we believe this exercise alleviates the anxiety associated with unfamiliarity as an important step in improving competence. In conclusion, the utilization of high-fidelity simulation training can increase resident preparedness as a leader in critical scenarios. CLINICAL IMPLICATIONS: The supplementation of high fidelity simulation-based training allows for effective, efficient, and multimodal training of residents. The acquired knowledge and skills can subsequently be applied to real-world patient care. DISCLOSURES: no disclosure on file for Jagadish Akella; No relevant relationships by Shiva Arjun, source=Web Response No relevant relationships by James Kang, source=Web Response No relevant relationships by Raghavendra Sanivarapu, source=Web Response No relevant relationships by Robert Sexton, source=Web Response No relevant relationships by Robin Sharma, source=Web Response