Education, Research, and Quality Improvement: Educator Breakout session |

Simulation-Based Training for Pulmonary and Critical Care Fellows in Urgent Endotracheal Intubation: Does Skill Transfer to the Clinical Arena? FREE TO VIEW

Ronak Shah, MD; Mina Makaryus; Matthew Feldman; Perry Mayo-Malasky, BA; Mangala Narasimhan, DO; Paul Mayo, MD; Effie Singas, MD
Author and Funding Information

Northwell/North Shore & LIJ, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):636A. doi:10.1016/j.chest.2016.08.728
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SESSION TITLE: Educator Breakout session

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Simulation-based training (SBT) for high-risk, low-frequency clinical events such as urgent endotracheal intubation (UEI) is a widely used training tool. Training effect is generally demonstrated by testing the learner on the simulator. We studied whether SBT for UEI performed by pulmonary/critical care medicine (PCCM) fellows transferred to real-life UEI.

METHODS: In July of 2015, four first-year PCCM fellows attended 15 mandatory training sessions to develop skill at UEI. Each session included a short didactic discussion followed by SBT using a computerized patient simulator (CPS). Sessions emphasized task training, crew resource management (CRM) communication, mastery of a Do/Confirm 46-point checklist, standard crew assignments, and combined team tactics. The fellows executed multiple scenarios of increasing complexity and stress with one fellow assigned to be team leader while the others assumed the roles of crew members on a rotating basis. Each scenario was followed by a formal debriefing session. At the end of the entire training period, each fellow was tested on the CPS while wearing a body mounted video camera. The same video assessment was done on the fellow’s first real patient UEI to evaluate if SBT translated to real-life patient encounter. Video recordings were scored by two independent investigators using a standardized score sheet. Forty of the 46 items on the checklist could be scored from the video recordings.

RESULTS: Results of testing on the CPS for execution of the checklist ranged from 36/40 (90%) to 40/40 (100%). Results of testing on real-life patient UEI for execution of the checklist ranged from 37/40 (92.5%) to 39/40 (97.5%). Use of task training, CRM, and combined team tactics was excellent with the CPS and real-life UEI with all fellows. There was minimal inter-observer variability in scoring.

CONCLUSIONS: SBT is an effective approach to train PCCM fellows in UEI. Video recording is a useful method to objectively assess the training effect of SBT for real-life patient UEI.

CLINICAL IMPLICATIONS: SBT for UEI appears to be effective and offers a safe means of training PCCM fellows in this high-risk, low-frequency event. Video recordings of real-life patient UEI are an important method to assess transfer of training effect to the clinical arena as well as to evaluate competency.

DISCLOSURE: The following authors have nothing to disclose: Ronak Shah, Mina Makaryus, Matthew Feldman, Perry Mayo-Malasky, Mangala Narasimhan, Paul Mayo, Effie Singas

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