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Education, Teaching, and Quality Improvement |

An Evaluation of Leadership and Teamwork Skills by Internal Medicine Residents During In-Hospital Cardiac Arrest and Rapid Response Scenarios After Simulation Training

Carla Venegas-Borsellino; Akiva Dym; Purnema Madahar; Eliany Mejia; Maneesha Bangar; Mai Colvin; Adam Keene; Lewis Eisen
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Montefiore Medical Center, Yonkers, NY


Chest. 2014;146(4_MeetingAbstracts):491A. doi:10.1378/chest.1991432
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Abstract

SESSION TITLE: Education and Teaching in Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 29, 2014 at 07:30 AM - 08:30 AM

PURPOSE: Internal Medicine residents are expected to lead and participate in rapid responses (RR) and cardiac arrests (CA). Advanced Cardiovascular Life Support (ACLS) guidelines stress the importance of effective teamwork and leadership during RR/CA scenarios. These skills are not innate. We hypothesized that simulation training offered during residency can improve residents’ teamwork and leadership skills during real RR/CA cases.

METHODS: A prospective, before-after study in 96 Medicine residents divided into groups that participated in 8 RR/CA cases using High Fidelity Simulation (HFS). Initially they were scored in 2 pre-training cases (n=36). This was followed by feedback regarding teamwork and resource management. Then they participated in 4 cases with feedback for education penetrance. Later they participated and were scored in 2 more cases as post-training evaluation (n=36). Finally, subjects were evaluated during actual in-hospital RR/CA events (n=28) three months after the simulation training. Teamwork was evaluated with the Mayo Teamwork Scale. Pre, post-training and real cases were compared and analyzed using STATA/IC.

RESULTS: The teamwork performance was evaluated during 28 adult in-hospital RR/CA cases. 57% (n=16) were RR, 43% (n=12) were CA. The overall mortality was 18%. Comparing pre vs post simulation training, general leadership/ teamwork skills improved from 26.5%+30% to 84.5%+30% (Δ+58% p<0.01), and was maintained during in-hospital RR/CA events 74.61%+32% (p<0.01). All skills showed statistically significant improvement during the in-hospital cases (p < 0.01). The greatest improvements were the teams’ ability to ask for clarification when needed (+100% p <0.01), respond to errors with procedures to prevent them (+78% p<0.01), and understand their role (+58% p <0.01). There was no difference between RR and CA performance (p >0.75).

CONCLUSIONS: Simulation training significantly improves teamwork/leadership skills as tested on a simulator. Importantly, these skills are maintained over time and are replicable during actual in-hospital RR/CA cases.

CLINICAL IMPLICATIONS: Training residents with HFS provides access to learning without compromising patient safety. Acquired teamwork/ leadership skills are maintained for application in real clinical scenarios.

DISCLOSURE: The following authors have nothing to disclose: Carla Venegas-Borsellino, Akiva Dym, Purnema Madahar, Eliany Mejia, Maneesha Bangar, Mai Colvin, Adam Keene, Lewis Eisen

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