Background:
Resuscitation is a vital part of pediatric residents’ education; however, evidence has
shown that during a 3 year residency period, live code blue scenarios in pediatrics are
rare due to the low number of cardiopulmonary arrests in the pediatric population.
Therefore, many residents do not feel confident in leading a code blue upon completion
of their training which leads to heightened anxiety and resistance
to taking leadership roles when a patient deteriorates. Because
experience is a major contributing factor to a resident’s leadership ability, we
conducted a needs assessment survey among residents and hospital personnel at our
institution. The survey confirmed the limited patient exposure and education in this
area. Mock code simulation is a way to advance education in cardiopulmonary arrest
scenarios, decrease resident anxiety and increase performance during a live code
event. While simulation lab training is a common mode of education, mock codes are
often underutilized in pediatric residency programs.
Purpose:
Effective leadership during a cardiopulmonary arrest event is a critical part of the clinical
outcome and success of the code. Due to limited pediatric code exposure, we have
endeavored to improve resident education on code scenarios through the development
and implementation of a mock code curriculum. We hope to improve resident
leadership and confidence in running a code as well as decrease anxiety and improve
patient outcomes. By including all supporting staff and personnel, we also aim to
improve teamwork, interdisciplinary communication and collaboration.
Description:
We have developed a mock code curriculum to enhance resident education. The mock
code simulation involves all the supporting staff as well the residents to give the most
accurate picture of a real life scenario. Each block rotation, 1 attending is designated as the Mentor of the Month to advise and advocate for the residents on their inpatient rotation.
This attending and the pediatric nurse coordinator are responsible for setting up a
mock code scenario twice during the rotation, one for the day team and one for
the night team. The hospital operator is notified and the code pager carried by the
senior resident is paged as well as the floor alarms activated just like a real code scenario. The nurse coordinator is present to give
background on the patient once the team arrives while the attending videos
the scenario. At the completion of the simulation, the video is reviewed and immediate
debriefing performed with all participating parties. Names are recorded and a post mock
code survey is sent out to obtain feedback on satisfaction, education and performance.
Then, these videos are further reviewed in more depth during the residents regularly
scheduled simulation lab time which occurs once per quarter.
Conclusions:
The curriculum has been piloted on pediatric residents rotating on the inpatient rotation
over the past 4 blocks. Preliminary results from the post mock code surveys and
informal resident feedback during debriefing sessions suggest interval improvement in
overall resident confidence with running a code, decreased anxiety with live code
scenarios, and increased resident satisfaction with their training exposure/education.
Implementing a mock code curriculum seems to be an effective way to supplement
pediatric residents education in light of limited patient code blue exposure. We
hypothesize that this will lead to increased provider proficiency, teamwork,
communication and better patient outcomes in the future.