In-situ Simulation-Based Module to Train Interns in Resuscitation Skills During Cardiac Arrest

Roshana Shrestha, Dinesh Badyal, Anmol Purna Shrestha, Abha Shrestha, Roshana Shrestha, Dinesh Badyal, Anmol Purna Shrestha, Abha Shrestha

Abstract

Purpose: Competency to perform cardiopulmonary resuscitation is essential to improve the outcome during an event of cardiac arrest. Medical internship is a "transition phase" beyond which physicians are exposed to the unpreparedness and anxiety while dealing with life-threatening conditions which need rapid actions. Experiential learning, deliberate practice and immediate feedback are the primary advantages of simulation-based medical education. In-situ simulation occurs in a real patient care environment utilizing the available resources. Our aim was to introduce in-situ simulation-based resuscitation skills training for medical interns.

Methodology: This was a prospective quasi-experimental study with mixed research design conducted in the emergency department. The knowledge score questionnaire, skill-score sheet, post-simulation feedback from the interns and staff were designed, validated through experts, peer-reviewed and pilot tested. All the interns posted in the emergency department participated in the training. Appropriate statistical analyses were applied for quantitative data. Thematic analysis of the data from the open-ended questions was used to identify the themes.

Results: Six groups of interns (n=35) participated in at least one of the 40 in-situ simulation sessions. The means of the pre- and post-simulation knowledge scores were 5.89± 2.8 SD and 11.74± 1.8 SD, respectively, and the difference was statistically significant [t (35) = 16.705, p<0.001]. The skill score had a positive correlation (Pearson correlation coefficient r=0.985, p=0.01) with the number of simulations performed in each group. The thematic analysis uncovered the themes related to the simulation methodology, reflective learning, enhancement of the non-technical skills and effective feedback. The self-reported enhancement in teamwork skills and the confidence level was significant. The feedback of the staff in the Emergency Department showed a positive attitude towards in-situ simulation.

Conclusion: This study demonstrated an increase in the knowledge and skills of the interns after participation in the in-situ simulation sessions. Based on the results, the study recommends that in-situ simulation-based teaching should be incorporated in the existing medical education system.

Keywords: cardiac arrest; debriefing; simulation-based medical education; teamwork skill; in-situ simulation.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2020 Shrestha et al.

Figures

Figure 1
Figure 1
Flow chart of methodology.
Figure 2
Figure 2
Simulation workshop by Prof Kristopher Brickman in collaboration with the University of Toledo, USA.
Figure 3
Figure 3
(A) Interns participating in the simulation as a team. (B) Interns participating in the simulation using defibrillator.
Figure 4
Figure 4
Debriefing session after the simulation.
Figure 5
Figure 5
Comparison of the pre and the post-simulation knowledge score.
Figure 6
Figure 6
Correlation between number of simulations and mean skill score.
Figure 7
Figure 7
Correlation between number of simulations and mean time to chest compression.
Figure 8
Figure 8
Feedback from the interns.
Figure 9
Figure 9
The self-reported pre- and post-simulation skills and confidence level of the interns in Likert scale (1=least, 5=most).
Figure 10
Figure 10
Feedback from the ED staff.

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