‘Constipation Challenge’ game improves guideline knowledge and implementation

doctor and are more commonly directed at surgical residents. The junior internal medicine residents indicated that they felt unprepared to take on the responsibilities of a senior medicine resident (SMR). Specific concerns were in regard to running code blue scenarios (cardiac arrest) and how to lead a clinical teaching unit (CTU) team. To address their concerns a 2-day intensive training course, the Senior Transition Education Program and Simulation (STEPS), was introduced at the end of their first year of training. Previously, there was no formal curriculum to prepare residents for the transition from junior to senior medicine resident. What was tried? Day 1 of the STEPS programme consisted of lectures given by attending physicians, fellow SMRs and support staff. Topics included leadership, professionalism in the emergency room (ER), a day in the life of an SMR, and responsibilities of an SMR as teacher and supervisor. Additional sessions involved rotations through six small-group learning stations that covered topics including managing a CTU team, understanding the ER admission algorithms, and when to call for help. Day 2 included several advanced cardiac life-support simulations that focused on leading the arrest team. Residents were surveyed before and after attending the STEPs course in regard to self-efficacy, confidence and preparedness. The survey combined use of rating scale-based questions and multiple choice knowledge-based questions. Results were analysed using a Wilcoxon signedranked test. What lessons were learned? Twenty-five of the 26 first-year residents completed the STEPS programme. Participation in the evaluation was voluntary. Fifteen residents completed both the before and after surveys. Residents self-rated their confidence and preparedness (1, not prepared at all; 5, being fully prepared). After the STEPS programme, significantly more residents described themselves as fully prepared for the following: assuming the role of an SMR (from 27.3% to 86.7%; p-value 0.006); managing a CTU team (from 46.7% to 86.7%, p-value 0.007); running a code blue (from 26.7% to 73.3%; p-value 0.0037); discussing end-of-life decisions with patients and family (from 71.4% to 100%; p-value 0.026); assuming the teaching roles of an SMR (from 6.7% to 57.1%; p-value 0.003); and knowledge about the ER algorithm (from 66.6% to 85.7%; p-value 0.013). Narrative feedback from the residents was unanimously positive, indicating appreciation of the educational opportunity and the support from their programme. The variety of learning techniques was highly praised, while indicating a lower interest in the didactic sessions. Residents’ comments indicated a desire for more involvement by current SMRs as teachers and more opportunities for participation in simulations that include personalised debriefing on their performance. The STEPS programme represents a successful strategy to prepare residents for their role as an SMR. The programme focused on development of leadership skills, team management and describing the local organisational processes. This innovative course will now be adopted as a mandatory component of training and a similar format could be adopted by other programmes and centres.