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The Effectiveness of a Novel Simulation Training Program for Resident Rapid Response Team Leaders
Education, Research, and Quality Improvement SESSION TITLE: Medical Education SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM
The Effectiveness of a Novel Simulation Training Program for Resident Rapid Response Team Leaders
PURPOSE: Although medical simulation has been shown to be superior to traditional education methods, there is minimal data on the effectiveness of simulation training for rapid response team (RRT) training. The aim of this study is to evaluate the effectiveness of simulation-based learning using the original and novel “ICRASHED” algorithm for RRTs on the self-confidence, knowledge and skills of internal medicine residents. METHODS: This was a single-center, retrospective study of a simulation-based educational intervention on RRT events for 28 internal medicine residents in post-graduate years 2 and 3 from an urban academic center. Pre- and post- surveys for selfconfidence and self-skill assessment on a graded Likert scale were completed on the day of training. The residents underwent a 3hour simulation-based training, using an institutional learning model. Skill performance was evaluated by a chief medical resident based on the components of the ICRASHED algorithm. Passing score was defined as greater than 65% correct. RESULTS: Self-confidence and self-skills assessment improved significantly after training. The median (IQR) pre- simulation selfconfidence was 3 (2-4) to 5 (4.5-6) post-simulation, (p = 0.02). Self-skill assessment score improved from 2 (2-3) to 3.5 (3-4) (p < 0.001). Residents performed well on the skills-based checklist with an overall score of 75% (67-81), with a 100% pass rate. The correlation of self-confidence assessment scores to overall test scores showed a trend towards a positive association (Chi Square 2.45, p = 0.48). CONCLUSIONS: Simulation-based training in ICRASHED, a novel RRT algorithm, improves resident self-confidence, self- skill assessment and technical skills in a simulated environment. Deliberate practice with a defined learning model ensures that each learner has achieved the necessary skill set to lead RRTs on patients. This study provides a preliminary model to train residents for the tense and chaotic environment of a decompensating patient. CLINICAL IMPLICATIONS: Nearly 17% of hospital admissions are complicated by a severe adverse event which has prompted the development of Medical Emergency Teams or Rapid Response Teams. Despite the need for such teams, data demonstrating the effectiveness of rapid response systems is conflicting. A proposed explanation for these variable results is the lack of a standardized management approach similar to ACLS. This study suggests that protocolized simulation-based training can improve team confidence and ability. Ideally, this preliminary model of training can translate into improved clinical outcomes. DISCLOSURE: The following authors have nothing to disclose: Nitin Kabra, Angela Love, Lina Miyakawa, Paru Patrawalla, Pierre Kory No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.581
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
chestjournal.org
551A
EDUCATION, RESEARCH, AND QUALITY IMPROVEMENT
Nitin Kabra Angela Love* Lina Miyakawa Paru Patrawalla and Pierre Kory Mount Sinai Beth Israel, New York, NY
The Effectiveness of a Novel Simulation Training Program for Resident Rapid Response Team Leaders
PURPOSE: Although medical simulation has been shown to be superior to traditional education methods, there is minimal data on the effectiveness of simulation training for rapid response team (RRT) training. The aim of this study is to evaluate the effectiveness of simulation-based learning using the original and novel “ICRASHED” algorithm for RRTs on the self-confidence, knowledge and skills of internal medicine residents. METHODS: This was a single-center, retrospective study of a simulation-based educational intervention on RRT events for 28 internal medicine residents in post-graduate years 2 and 3 from an urban academic center. Pre- and post- surveys for selfconfidence and self-skill assessment on a graded Likert scale were completed on the day of training. The residents underwent a 3hour simulation-based training, using an institutional learning model. Skill performance was evaluated by a chief medical resident based on the components of the ICRASHED algorithm. Passing score was defined as greater than 65% correct. RESULTS: Self-confidence and self-skills assessment improved significantly after training. The median (IQR) pre- simulation selfconfidence was 3 (2-4) to 5 (4.5-6) post-simulation, (p = 0.02). Self-skill assessment score improved from 2 (2-3) to 3.5 (3-4) (p < 0.001). Residents performed well on the skills-based checklist with an overall score of 75% (67-81), with a 100% pass rate. The correlation of self-confidence assessment scores to overall test scores showed a trend towards a positive association (Chi Square 2.45, p = 0.48). CONCLUSIONS: Simulation-based training in ICRASHED, a novel RRT algorithm, improves resident self-confidence, self- skill assessment and technical skills in a simulated environment. Deliberate practice with a defined learning model ensures that each learner has achieved the necessary skill set to lead RRTs on patients. This study provides a preliminary model to train residents for the tense and chaotic environment of a decompensating patient. CLINICAL IMPLICATIONS: Nearly 17% of hospital admissions are complicated by a severe adverse event which has prompted the development of Medical Emergency Teams or Rapid Response Teams. Despite the need for such teams, data demonstrating the effectiveness of rapid response systems is conflicting. A proposed explanation for these variable results is the lack of a standardized management approach similar to ACLS. This study suggests that protocolized simulation-based training can improve team confidence and ability. Ideally, this preliminary model of training can translate into improved clinical outcomes. DISCLOSURE: The following authors have nothing to disclose: Nitin Kabra, Angela Love, Lina Miyakawa, Paru Patrawalla, Pierre Kory No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.581
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
chestjournal.org
551A
EDUCATION, RESEARCH, AND QUALITY IMPROVEMENT
Nitin Kabra Angela Love* Lina Miyakawa Paru Patrawalla and Pierre Kory Mount Sinai Beth Israel, New York, NY