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Simulation Training During Internal Medicine Residency

Effective communication and leadership are skills vital to running a high-quality cardiopulmonary resuscitation, but these aspects of physician’s behavior are rarely taught as part of conventional medical education. ACLS courses practically ignore the behavioral skills necessary to successfully manage these emergencies. Communication failure is the leading cause of inadvertent patient harm. The central factor in team performance is communication. Individual skills and knowledge are necessary, but not sufficient for successful team performance.

High-fidelity patient simulators promise to enhance the efficiency of learning in a safe environment, consistently allowing medical trainees to gain clinical experience without depending on chance encounters with real patients. In a general sense, it improves patient safety by allowing the residents to become better trained without putting patients at risk. The use of the Baystate Simulation Center and Goldberg Surgical Skills Lab offers an excellent alternative for systematic training and evaluation of residents’ skills in managing these critical events.

In our Medicine and Medicine-Pediatrics residency programs, we use human patient simulators to help teach leadership as well as organizational and practical skills in the “Code blue “setting. All second-year Medicine residents and second- and third-year Medicine-Pediatric residents function as code leaders for all of the main cardiac arrest scenarios in the Baystate Simulation Center. Through direct observation of resident performance in a created environment and by use of reinforcement we are able to change the residents’ behavior to be effective code leaders.

With the goal of improving performance, we are teaching residents the principles of leadership and communication between team members in the simulation lab. We developed a protocol that corrects and increase the skills and comfort level of residents on a code team, with particular attention to the team leader. By evaluating these behavioral skills it became possible to identify areas of strength and weakness, and also target the teaching of an individual for his/her specific needs.

Using human patient simulators, we present cardiac arrest cases allowing for repetition in a low-risk, supportive learning environment. An attending physician and the simulation instructor evaluate the team leader through a standard evaluation and decide if the resident needs more practice sessions in the simulation center. Residents have the opportunity to schedule additional sessions until they feel confident and comfortable to be code leader.