Code blue situations, being uncommon yet stressful, require excellent team communication; they can pose challenges for deaf or hard of hearing (DHH) clinicians, trainees, and interpreters, though DHH providers are a growing source of language-concordant care for DHH people, an underserved population. No known training specifically addresses such challenges. As educators and mentors, we receive frequent questions about participating in and communicating during critical care. In response, we created a clinical simulation workshop.


Participants will 1) identify roles in codes, and 2) describe challenges/adaptations for the DHH clinician or interpreter and 3) effective communication techniques when interpreting.


Our team consisted of a deaf hospitalist (CM), emergency medicine physician (DM), and healthcare interpreter (TA); we each mentor DHH clinicians, students, and healthcare interpreters. With mentee input, we developed a workshop for a national meeting of DHH health care professionals/students in 2015.

The four-hour workshop occurred twice in two days at the Univ. of Michigan-Ann Arbor’s simulation center. We defined “code,” described roles (e.g. chest compressions, leading), and elicited attendee knowledge of and questions about code participation/communication. We then identified common challenges to DHH participants’ communicating effectively with hearing colleagues and interpreters.

We then portrayed a ventricular fibrillation code, emphasizing communication techniques. Participants engaged in hands-on simulated code cycles in various roles, including code leader. Each cycle provided clinical scenarios (e.g. loss of consciousness) and cardiac rhythms (e.g. asystole) in incremental challenges. Each cycle included difficulty with at least one of the following: seeing one another, hearing one another, finding a place to stand, or unexpected experiences (e.g. body fluid exposure). Post-cycle reflection began with participants, followed by observer input.

We used 30 minutes for final debriefing.

34 of 73 participants were DHH; attendees included 16 physicians, 2 premedical students, 4 nurses, 2 physician assistants, and 32 sign language interpreters. Only 5 people reported participating in codes at least monthly; 34 did so at most a few times annually. 46 reported having basic/advanced life support training.

Participants completed pre- (55) & post-tests (42).

Pre-workshop: 14 reported feeling somewhat/very comfortable with participating. 16 reported feeling somewhat/very comfortable communicating in codes.

Post-workshop: 30 reported feeling somewhat/very comfortable participating. 34 reported feeling somewhat/very comfortable communicating in codes.


Our interdisciplinary workshop mentored DHH clinicians, students, and interpreters in simulated codes, focusing on interprofessional communication. Post-workshop debriefing supports this initial innovation as a means of promoting professional development for high-stakes clinical situations. Any institution seeking to boost critical care communication for DHH students/clinicians can replicate this workshop.