Physicians in Training and Critical Care Nurses Performance in Medical Code Events: Effect of Simulation-Based Training

Study Overview
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Brief Summary
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METHODS: Subjects: All internal medicine (IM), emergency medicine (EM), anesthesia (A), surgery (S) residents and all hospital ICU nurses (approximately 400 subjects) will be undergoing evaluation and training in CPR techniques according to their department training policy. Study Assessment Tool: An objective assessment tool has been developed and tested in medical code scenarios during training sessions recently done in the simulation lab. The tool has five domains: Airway, Breathing, Circulation, Communications/Leadership, and Defibrillation. Each domain consists of 3-8 tasks and skills (attachment A). Design: Phase I: In groups of five to six subjects, residents and nurses will undergo baseline assessment in CPR techniques in the simulation lab. Subject will be presented with a clinical scenario that includes cardiopulmonary arrest. Subjects will be scored by observers based on the previously described assessment tool and will be video recorded. Phase II: All study subjects who completed phase I assessment will undergo standardized debriefing and demonstration of proper CPR techniques after reviewing their individual baseline videotape followed by repeated demonstration in CPR techniques during a clinical scenario with cardiopulmonary arrest in the simulation lab. Knowledge retention will be assessed periodically. Phase III: Rates of survival to hospital discharge and survival at 24 hours in hospitalized patients after cardiopulmonary arrest collected by the CPR committee and QA department longitudinally for one year after completion of project training (phase II) will be reviewed and compared to the same period one year earlier (CPR outcome data are being collected since 2005 at St. Luke's-Roosevelt Hospitals).

Official Title
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Physicians in Training and Critical Care Nurses Performance in Medical Code Events: Effect of Simulation-Based Training

Conditions
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Ventricular Fibrillation

Intervention / Treatment
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* Behavioral: Simulation-Based Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Physicians in training and nurses Exclusion Criteria: Physicians in training and nurses refusing to have their data included in final analysis

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Physicians<br>Physician in training: All internal medicine (IM), emergency medicine (EM), anesthesia (A), surgery (S) residents and all hospital ICU nurses. | Behavioral: Simulation-Based Training<br>* An objective assessment tool has been developed and tested in medical code scenarios during training sessions recently done in the simulation lab. The tool has five domains: Airway, Breathing, Circulation, Communications/Leadership, and Defibrillation. Each domain consists of 3-8 tasks and skills.<br>|
| Other: Nurses<br>Nurses in Training | Behavioral: Simulation-Based Training<br>* An objective assessment tool has been developed and tested in medical code scenarios during training sessions recently done in the simulation lab. The tool has five domains: Airway, Breathing, Circulation, Communications/Leadership, and Defibrillation. Each domain consists of 3-8 tasks and skills.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Performance scale | Change in performance scale at 1 year as compared to baseline | Baseline and 1 year | 
| Rates of survival | Rates of survival to hospital discharge after cardiopulmonary arrest one year after completion of the simulation based training in CPR | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survey questionnaire | Change in survey questionnaire score at 1 year as compared to baseline. The questionnaire consists of 4 parts, including: adequacy of training, sense of preparedness, supervision and feedback, and general information. With the exception of the section on general information, responses are scored on a 5 point Likert scale. | Baseline and 1 year | 
| Perceptions of preparedness | Change in perceptions of preparedness at 1 year as compared to baseline. The method of assessment for this outcome measure is the Likert Scale | Baseline and 1 year |