From the 2024 HVPA National Conference
Moe Ameri, Doctorate of Medicine (University of Texas Medical Branch), Michelle Yang, Bachelor of Science (University of Texas Medical Branch John Sealy School of Medicine), Erin Hommel, Doctorate of Medicine, Jacob Alaniz, Bachelor of Arts, Aesha Aboueisha, Doctorate of Medicine, Jose Lulli Cantoni, Doctorate of Medicine, Edward Butt, Doctorate of Medicine, Ravi Thakker, Doctorate of Medicine, Hwe Won Lee, Doctorate of Medicine, Kian Abdul-Baki, Doctorate of Osteopathic Medicine, Jordan Malone, Doctorate of Osteopathic Medicine
Background:
Cardiopulmonary arrests are a prevalent and critical contributor to in-hospital morbidity and mortality. In academic hospitals, leading code teams often fall upon internal medicine residents certified in advanced cardiac life support (ACLS). However, residents are inconsistently trained in code leadership and exposed to other code roles, leading to low confidence and suboptimal performance in running codes. We developed a comprehensive code simulation curriculum for internal medicine residents to reinforce ACLS competencies and cultivate crucial communication and leadership skills for effectively orchestrating code responses.
Objective:
To develop and evaluate a comprehensive code simulation curriculum to reinforce Advanced Cardiac Life Support (ACLS) competencies and enhance communication and leadership skills among internal medicine residents for effective code response management.
Methods:
An interdisciplinary team comprising internal medicine residents, faculty physicians, nurses, and ACLS educators was formed to enhance the skills necessary for leading successful in-hospital cardiopulmonary arrest responses. We identified key areas for improvement, including up to date ACLS knowledge, familiarity with code cart contents, defibrillator use, and leadership and communication within code teams. We developed didactic lectures on ACLS algorithms and differential diagnoses for cardiac arrest causes and introduced a one-hour simulation training with high-fidelity mannequins depicting typical scenarios. All internal medicine residents completed this mandatory training, which featured pre-briefing, two simulated codes, and structured debriefing focusing on ACLS protocols and team management strategies.
To measure the curriculum’s effectiveness, our residents took pre- and post-training surveys evaluating their code-related knowledge and skills and assessing the didactic and simulation training. We also reviewed adult in-hospital code outcomes, analyzing the return of spontaneous circulation rates and ACLS compliance using descriptive statistics, paired t-tests, and Chi-Square and Fisher Exact Tests.
Results:
Out of 95 trained residents, 38 completed the pre-survey, and 35 completed the post-survey, with 14 providing data to permit a pre-post paired analysis. Statistically significant improvements were observed in self-rated abilities for applying the ACLS algorithms, performing intraosseous access, diagnosing and treating reversible code causes, appropriately using code medications, and completing post-code documentation (p-values ranging from 0.002 to 0.040). The simulation training was rated helpful by 84% of residents, compared to 59% for the didactic sessions. Among actual adult in-hospital code outcomes, we demonstrated statistically significant improvement in achieving return of spontaneous circulation (ROSC) post-training (p=0.020).
Conclusions:
We demonstrated statistically significant improvement in residents’ confidence to manage and lead in-hospital cardiopulmonary resuscitation following a combined didactic and experiential simulation-based curriculum. This correlated with actual improvements in return for spontaneous circulation among adults experiencing in-hospital cardiac arrest. The curriculum complements traditional ACLS training, focusing on real-world applicability, communication skills, and interdisciplinary collaboration.
Clinical Implications:
This initiative has significantly improved the quality and safety of patient care by ensuring better-prepared internal medicine residents for adult in-hospital cardiopulmonary arrests. We used cases highlighting frequently encountered causes for in-hospital arrest to increase the impact of our curriculum. By keeping training sessions brief, we could feasibly accommodate all residents in the training. Over time, residents expressed significant value in frequent, brief simulation training to keep their ACLS skills sharp, given the unpredictable frequency at which they encounter and lead the in-hospital cardiopulmonary arrest team.