PURPOSE: Internal medicine residents serve as code team leaders in US hospitals. Preparation for this role is variable but often consists only of ACLS certification. This study sought to determine internal medicine residents’ baseline knowledge of ACLS using a high fidelity simulation system (SimMan).
METHODS: Three scenarios, each comprised of four different, sequential arrhythmias were programmed into SimMan. Residents then completed a baseline scenario. Performance scores were generated using a clinically based, absolute value scoring system created by the authors. The scoring system was weighted such that serious errors (e.g. incorrect rhythm identification) received greater penalties. Residents were asked to self-report months since ACLS training. SPSS 14.0 was used for statistical analysis.
RESULTS: A total of 56 internal medicine residents evenly distributed with regards to post-graduate year (PGY1-3) completed the study. The median score was11.5 (IQR=9-13) out of a maximum possible score of 16. A common mistake was incorrect rhythm identification (11%, n=57/522) with different frequencies depending on type of arrhythmia (Table 1). Other errors included inappropriate use or nonuse of cardioversion, medications, and diagnostic testing. The median time since ACLS training was 10 months (IQR=6-18) months and there was not a significant relationship between time since ACLS training and score (Figure 1, r2=.008, p=.5). However, there was a significant improvement in score by post-graduate year (p<.05).
CONCLUSION: Current ACLS training is insufficient for resident competency in codes. Without an improved educational model for ACLS, resident learning is relegated to trial-and-error on patients and represents a significant vulnerability to patient safety.
CLINICAL IMPLICATIONS: Training for leadership of inpatient code teams should be improved. Misidentification of arrhythmia will result inappropriate ACLS therapies and thus is of particular concern. PEA is the most common in-hospital arrhythmia but residents often fail to recognize it. Ventricular tachycardia and fibrillation have relatively good prognosis if correctly treated but are often misidentified. High fidelity simulation systems offer an opportunity for real-world training without risk to real patients.
DISCLOSURE: Dee Ford, None.