Senior internal medicine residents who are trained in critical resuscitation skills on patient simulators become more skilled than residents who undergo traditional training, according to new research. Though prior studies have already shown that simulation training is effective in imparting such skills, this study, which appears in the December issue of the journal Chest, sought to demonstrate the superiority of simulation training over traditional methods. In doing so, researchers found that simulation-trained residents out-performed their traditionally trained counterparts in 8 of the 11 steps of initial airway management during a simulated scenario of respiratory arrest.
"We weren't surprised by the skills demonstrated in the simulation-trained residents, although we were quite surprised to see how poorly the traditionally trained residents performed," said study author Pierre Kory, MPA, MD, Senior Pulmonary and Critical Care Fellow, Beth Israel Medical Center in New York. "This finding was quite alarming because traditional training or 'learning by doing' is how doctors have historically been trained and continue to be trained, around the world."
Dr. Kory and his colleagues from Beth Israel Medical Center compared two groups of third-year internal medicine residents; one group received training in initial airway management skills using a computerized patient simulator during the first year of residency while the other group received traditional residency training. This "traditional" training, also known as experiential or apprenticeship training, involves the resident learning on the job, whereas simulated training involves creating medical scenarios using human-sized mannequins equipped with realistic features, including pulses, chest wall movements, and audible breath sounds. To assess their skills in initial airway management, both groups were presented with a simulated scenario of a patient who had suddenly stopped breathing. Performance scores in the scenario were based on the successful completion of 11 standard tasks necessary for success in improving blood oxygen level, providing oxygen, and delivering adequate breaths to a patient who cannot breathe independently.
"In this scenario, the mannequin was programmed to represent a respiratory arrest situation, but not a cardiac arrest. This means that the 'patient' had stopped breathing, but the heart was still beating," Dr. Kory explained. "The situation required that residents recognize this clinical state and take certain initial steps of airway management. We then scored each task as completed or not completed."
Researchers found that 38% of the simulation-trained residents, compared with 0% of the traditionally trained residents, successfully resuscitated the mannequin. In addition, the simulation- trained residents performed significantly better in 8 of the 11 tasks of initial airway management. Researchers also found that only 20% of traditionally trained residents were able to successfully attach a CPR-bag-valve-mask to oxygen, insert an oral airway device, or achieve an adequate seal over the mouth with the CPR-bag-valve-mask. According to Dr. Kory, this demonstrates a serious and pervasive deficiency in critical resuscitation skills.
"It is so important for residency training program directors, and medical educators in general, to realize just how poor doctors' resuscitation skills are overall. While the simulation- trained residents did better, only 38% were successful at resuscitating a simulated patient. These same residents had shown perfect performance at the end of the training program during their first year of residency, so there was a significant deterioration in skill level," he said. "What this means is that more frequent scenario-based training sessions should be provided."
"Patients should have the peace of mind of knowing that their treating physician could save their life, should they suddenly stop breathing," said Alvin V. Thomas, Jr., MD, FCCP, President of the ACCP. "Simulation training can provide efficient and effective learning in not only airway management, but in a number of areas where critical skill is required."