Background: The Internal Medicine and Family Medicine residency programs were established at Hillsboro Medical Center (HMC), a small-sized community hospital, in 2021. As the multidisciplinary healthcare team adapts to incorporate resident trainees into the clinical workflow, the lack of resident exposure to Code Blue and rapid response scenarios was observed. Limited hands-on experience during medical school training could have also contributed to this. In our need assessment, we identified that residents needed to be better equipped with skills to handle cardiac arrest, acute stroke, and rapid response calls. As the inaugural class transitioned to their senior roles, there was a pressing need to rapidly develop and implement simulation-based training to hone their skills in these areas. The limited staffing resources at a community-based program also need to be considered. To meet this demand and consider the feasibility, our hospitalist faculty developed the Hospitalist-led Mock Code Collaborative Project for Residents (HMC-CPR), a longitudinal simulation-based curriculum guided by the Stanford educational framework.
Purpose: The curriculum will ensure residents develop the competency of managing Code Blue, rapid responses, Code stroke, in collaboration with the multidisciplinary team during training. Specific objectives include: 1) Residents develop an organized approach in leading the response in code blue and rapid response; 2) Residents develop the confidence of responding to rapid response through hands-on simulation and spaced repetition; 3) Residents develop skills in collaborating with multidisciplinary team during these scenarios. A hospitalist-led longitudinal simulation-based curriculum is the most feasible way to achieve these goals. Simulation provides a safe learning environment and enhances learning, and longitudinal sessions provide spaced repetition to enhance retention of knowledge and skills. Hospitalists provide most inpatient care and respond Code Blue. They are best suited to lead the collaboration and provide invaluable feedback following each simulation case.
Description: The curriculum consists of quarterly didactics and simulation-based training sessions, one scheduled every month from September to November in our education center, and additional mock code sessions per month from December to May in the hospital. The didactics cover current ACLS guidelines, NIHSS scale, and approaches to common rapid response scenarios. Each simulation session lasts 90 minutes and comprises of 3 hands-on emergency medical scenarios. Each session starts with an overview of the basic principles, a review of the first two minutes into the Code Blue using the I(CA)RAMBO mnemonic, and a demonstration of defibrillator use followed by debriefing. Residents rotate between their roles as code leaders and team members. As a primary stroke center, hospitalists attend to inpatient Code Stroke. With the new residency programs, residents participate in Code Strokes, so they must learn how to perform the NIHSS. We are also conducting surveys to evaluate the quality and outcome of this curriculum formally.
Conclusions: Hospitalists played diverse roles in various situations. In a community hospital, we can provide invaluable support for new medical residency programs, using our expertise to improve learners’ skills in managing critically ill patients. This innovative approach holds great promise for enhancing the program’s curriculum.