Using Simulation Education With Deliberate Practice to Teach Leadership and Resource Management Skills to Senior Resident Code Leaders

摘要

What was known Simulation-based education with deliberate practice can promote skill acquisition.;What is new Study assesses internal medicine residents' skills after a simulation-based intervention compared to a traditional lecture format to learn team communication and crisis resource management (CRM).;Limitations Single institution, and small sample size limit generalizability.;Bottom line Residents exposed to simulation communicated and completed CRM skills more effectively than those taught in a lecture format.;Introduction Effective communication and coordinated teamwork are critical to the successful management of complex events such as cardiac arrests or “codes.”1–5 Delays in resuscitation can result in poor outcomes.6–8 The essential “call for help” summons the emergency response personnel that the code leader must direct.1 While crisis resource management (CRM) skills have been adapted from industry to medicine to enhance team performance,3,9–15 these skills often are not explicitly taught during medical education.3,9,12,13,16–19 Simulation-based education improves learner knowledge and skills, and allows practice in controlled, safe environments.12,13,20 Deliberate practice, a feedback-based educational method, requires continued practice of challenging skills.21,22 Simulation-based education combined with deliberate practice8–26 promotes skill acquisition27–32 and adherence to Advanced Cardiac Life Support (ACLS) algorithms.25,26,32 Senior internal medicine residents at Cooper University Hospital routinely act as code leaders. All receive medical education about codes, but not CRM skills required to manage resuscitation efforts. We hypothesized that using simulation with deliberate practice to teach CRM skills to code leaders would improve performance of targeted measures when compared with a lecture format.;Methods For academic years 2006–2007 through 2008–2009, all senior postgraduate year (PGY)–3 internal medicine residents were invited to participate in the study. Participants within each year were randomly assigned to 2 groups: the lecture (LEC) group attended 2 lectures about team management, and the simulation (SIM) group engaged in simulation-based education with deliberate practice sessions (figure). View larger version (16K) FIGUREStudy Design;Results Preintervention Three groups of PGY-3 residents (19 in 2006, 19 in 2007, and 18 in 2008) were enrolled for a total of 56. Four participants (2 each in 2006 and 2007) were unavailable for the intervention, leaving 52 participants. The participants in each group were similar with respect to training level, age, and experience. All 52 attempted ventilation and 92% (48 of 52) did call for help. Seventy-eight percent (41 of 52) failed to successfully ventilate the patient, and all continued to attempt ventilation without asking for assistance from the arriving anesthesiologists. In all cases of failed ventilation, the simulated patient died (table?2). Debriefing revealed that the participants recognized their inability to manage available resources. Sixty-four percent (27 of 41) of those who could not ventilate the patient were aware of their ineffective ventilation, and none requested help.;Discussion Our study showed that simulation-based education with deliberate practice of CRM skills resulted in improved rare event and team management by senior internal medicine resident code leaders. While lecture format yielded some improvement in team and event management, the improvement was significantly greater for members of the simulation training group, especially for communication results. During debriefing sessions, participants disclosed difficulties they encountered while attempting to manage the event and team. While the LEC group demonstrated improved management, they reported that they did not feel comfortable asking the team for suggestions. In contrast, SIM participants reported that these sessions taught them to ask the team for help, resulting in greater