Background: A core ability of a capable Internal Medicine resident is ability to manage inpatient emergencies like arrhythmias and cardiac arrest. However, between 30-35% of first-year residents at our residency program fail their first attempt at an arrhythmia and cardiac arrest simulation exam, and more than 75% report not feeling confident by the end of their first year.
Purpose: Several studies have shown that simulations have durable, positive impacts on confidence, attitudes, and knowledge of residents in emergency situations (1,2). However, these simulations often occur during academic half days, which are already accounted for by other curricula in our program. In this context, we designed and implemented a one-week rapid response and cardiac arrest curriculum during noon conference to provide residents with necessary didactic and simulation experience during their intern year, prior to their end-of-year graded simulation exam.
Description: Our arrythmia and cardiac arrest simulation curriculum occurs over five consecutive days of resident noon conferences. The first day is a didactic on tachyarrhythmias and cardiac arrest. The second day provides hands-on training for placing intraosseous access, operating a defibrillator, and exploring the contents of the crash cart. The final 3 days assign two medicine wards teams (each comprised of 2-3 interns, 1 resident, and up to 2 medical students) to undergo an observed simulation using a Laerdal Sim-Man 3G simulation mannequin. The simulation covers stable supraventricular tachycardia, unstable ventricular tachycardia (VT), and VT cardiac arrest. We encourage first-year residents to take the primary leadership role in the simulation. We use the same rubric as the formal assessment discussed above to provide individual feedback at the end of the simulation. All participants are asked to complete an anonymous survey before the first didactic session and after their simulation. The pre- and post-surveys are identical 21 question forms, with 14 questions assessing resident attitudes towards various elements of a code using a 5-point Likert scale, six knowledge assessment questions, and one question to identify year of training. We then compared the pre- and post-course results using student’s t-tests.
Conclusions: From our first of five planned sessions in the 2024-2025 academic year, we have had 18 participants total. 12 (67%) responded to our pre-survey, and 7 (**39%) responded to our post-survey. Our preliminary data demonstrates that both resident attitudes and knowledge significantly improved after the simulation experience. Ten of the 14 attitude questions on topics such as confidence using ACLS algorithms, using cardioversion and transthoracic pacing, and medication dosing and timing showed significant improvement. There were 59.7% correct answers on the pre-survey knowledge assessment and 95.2% correct on the post-survey, also a significant improvement. Among the questions that do not show a statistically significant difference includes one on identifying arrhythmias, which showed the highest confidence level at baseline. Other non-significant questions focus on the desire to participate in more simulation activities, which again have high baseline average positive responses on the Likert scale. In conclusion, we have developed and implemented an arrhythmia and cardiac arrest simulation curriculum utilizing available resident education time that has significantly improved confidence and knowledge.