In Situ Simulation for Ventilator Management in Emergency Medicine

Emergency physicians have a residency graduation milestone to effectively manage the airway and initiate mechanical ventilation. However, many emergency medicine (EM) residents report rarely or never feeling comfortable managing mechanically ventilated patients. Our goal was to determine the effectiveness of an in situ simulation program for EM residents to successfully manage a ventilator on a high-fidelity patient simulator.

This was a prospective observational educational study of EM residents executed in four steps. Baseline performance was assessed by observed standard clinical examination (OSCE) in a checklist manner after our routine classroom-based annual ventilator teaching. The in situ simulation was executed in a small-group format located in the trauma bay of the ED using only equipment available in the clinical setting. Performance at 1 week and 8 months after the educational intervention was assessed by repeat OSCE. The results were assessed using paired Student's t-tests.

There was a statistically significant improvement in all checklist markers of successful ventilator management on repeat OSCE after the in situ simulation intervention. A final unannounced retention OSCE was administered 8 months after the intervention with no additional interval training. The improved performance persisted 8 months later.

This in situ simulation study demonstrated improved checklist scoring on ventilator management in simulated critically ill patients by EM residents. This improvement persisted 8 months after the educational intervention.