Does Simulation Training in Code Blue Situations Improve Resident Comfort in Code Blues?

Abstract

Purpose: Teaching hospitals use resident led teams to conduct code blues which can be stressful for physicians-in-training. Though Advanced Cardiac Life Support certification is required, most institutions do not require or offer further training. Code blue simulation training may allow residents to become more comfortable with code blue scenarios and complications. Methods: Internal medicine (IM) residents at Baylor University Medical Center were trained in a 3G SimMan lab and given formal lectures addressing key aspects of a code blue. They were surveyed prior to training and following a 12-month period where 21 IM residents were exposed monthly to various and progressively more challenging arrhythmias and code scenarios. Internal medicine and critical care faculty provided coaching and feedback with immediate debriefing to improve skills and confidence during a code. Results: A total of 21 residents completed the initial survey and 19 completed the post training survey. The data were analyzed using a Krukal-Wallis test to indentify a difference between the pre and post training surveys regarding three specific questions. “How comfortable are you at a code and assuming the lead when someone already is in the lead role?” p-value 0.184 “How comfortable are you speaking to family regarding the events and outcome of a code?” pvalue 0.149 “How comfortable are you addressing code status following a code if you regain a perfusing rhythm?” p-value 0.201 Conclusions: Survey assessment did not show a statistically significant difference in the improvement of confidence level between pre and post surveys with regard to our questions. This is most likely due to the small sample size and the lack of power to detect a difference as significant. While no statistical significance was found, a trend toward improving comfort levels can be seen from the descriptive statistics. We did not ask on the survey if residents had the perception that code blue simulation improved their comfort level. Clinical Implications: Given the trend towards improving comfort levels and the frequency of resident led codes in teaching hospitals in the U.S., further studies with a larger sample size are needed to see if simulation training improves resident comfort level during codes. Studies should also evaluate if training impacts code outcomes.