Chest
Volume 133, Issue 1, January 2008, Pages 56-61
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Original Research
EXPERIENTIAL LEARNING
Simulation-Based Education Improves Quality of Care During Cardiac Arrest Team Responses at an Academic Teaching Hospital: A Case-Control Study

https://doi.org/10.1378/chest.07-0131Get rights and content

Background

Simulation technology is widely used in medical education. Linking educational outcomes achieved in a controlled environment to patient care improvement is a constant challenge.

Methods

This was a retrospective case-control study of cardiac arrest team responses from January to June 2004 at a university-affiliated internal medicine residency program. Medical records of advanced cardiac life support (ACLS) events were reviewed to assess adherence to ACLS response quality indicators based on American Heart Association (AHA) guidelines. All residents received traditional ACLS education. Second-year residents (simulator-trained group) also attended an educational program featuring the deliberate practice of ACLS scenarios using a human patient simulator. Third-year residents (traditionally trained group) were not trained on the simulator. During the study period, both simulator-trained and traditionally trained residents responded to ACLS events. We evaluated the effects of simulation training on the quality of the ACLS care provided.

Results

Simulator-trained residents showed significantly higher adherence to AHA standards (mean correct responses, 68%; SD, 20%) vs traditionally trained residents (mean correct responses, 44%; SD, 20%; p = 0.001). The odds ratio for an adherent ACLS response was 7.1 (95% confidence interval, 1.8 to 28.6) for simulator-trained residents compared to traditionally trained residents after controlling for patient age, ventilator, and telemetry status.

Conclusions

A simulation-based educational program significantly improved the quality of care provided by residents during actual ACLS events. There is a growing body of evidence indicating that simulation can be a useful adjunct to traditional methods of procedural training.

Section snippets

Design

This was a retrospective case-control study20 of cardiac arrest team responses at Northwestern Memorial Hospital (NMH) from January to June 2004. An educational program had been started 6 months earlier for second-year internal medicine residents featuring simulation-based training in ACLS. A 6-month study period was selected because it provided an opportunity to compare two groups of ACLS team leaders as a natural quasi-experiment.21 Cases and controls are team responses to ACLS events divided

Results

The mean interrater reliability for the 20 randomly selected ACLS events across the eight performance measures was high (κ = 0.87). This indicates that there was very little disagreement about abstraction of ACLS performance data.

Twenty ACLS events were led by simulator-trained second-year residents and 28 were led by traditionally trained third-year residents. As shown in Table 1, no difference between patients in either group was shown by age, ventilator, or telemetry status.

Simulator-trained

Discussion

This study amplifies the outcomes of past research on simulation-based ACLS medical education by extending those research findings to the quality of care provided during real ACLS events. Our prior work documented the ability of simulation-based training to significantly increase residents' ACLS skills,6 to allow for the setting of mastery standards,7 and to demonstrate the retention of skill over a 14-month study period.8 The research situation described in this article presented a unique

ACKNOWLEDGMENT

We thank the Northwestern University internal medicine residents for their dedication to patient care and education. We acknowledge Charles Watts, MD, and J. Larry Jameson, MD, PhD, for their support and encouragement of this work. We appreciate the input of anonymous reviewers who helped to strengthen this article.

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    The study was supported by the Excellence in Academic Medicine Act of the Illinois Department of Public Aid administered through Northwestern Memorial Hospital.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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