Simulation Improves Internal Medicine Resident Confidence With Defibrillation, Cardioversion, and Transcutaneous...

Area of Science:

• Medical Education
• Cardiology
• Simulation Training

Background:

• Graduate medical education programs often lack comprehensive training for cardiac stabilization in patients with a pulse.
• Residents frequently manage patients with life-threatening dysrhythmias but report low confidence in these critical skills.
• Current Advanced Cardiac Life Support (ACLS) certification does not fully address all aspects of cardiac stabilization.

Purpose of the Study:

• To assess the effectiveness of simulation-based training in improving resident confidence in managing life-threatening dysrhythmias.
• To evaluate the sustainability of confidence gains at six and 11 months post-training.
• To identify potential skill degradation over time and inform future training intervals.

Main Methods:

• A pre-post survey design using a modified Likert scale was employed to measure resident confidence.
• A 1-hour hands-on simulation training session focused on critical cardiac stabilization domains.
• Internal medicine, preliminary medicine, and transitional year residents participated in the study.

Main Results:

• Resident confidence in key domains (defibrillation, cardioversion, pacing) significantly increased immediately after training (p<0.001).
• This enhanced confidence was sustained at six (p=0.001) and 11 months (p=0.002) post-training.
• A slight, yet statistically significant, decrease in confidence was observed at six and 11 months compared to immediately after training (p=0.01, p=0.004).

Conclusions:

• Simulation-based training is an effective method for enhancing resident confidence in managing patients with life-threatening dysrhythmias.
• While confidence is sustained, gradual degradation over time suggests a need for periodic refresher training.
• Further research should focus on determining optimal intervals for retraining to maintain high levels of proficiency.