Education Research: "Simulation Sharing": Use of a Cardiac Arrest Management Course Developed for Medicine Residents Applied to Neurocritical Care Fellows.

Abstract

Background and objectives: Neurologists, especially neurointensivists, may be expected to lead cardiac arrest resuscitations. However, neurocritical care (NCC) fellows may face barriers to acquiring the necessary skills and knowledge needed for successful leadership in these scenarios. Whether a simulation course created for one group of learners and applied in a new context (a "shared simulation") could facilitate acquisition of desired outcomes among neurology learners is unclear.

Methods: In this prospective, pre-post educational intervention study, NCC fellows at 2 centers completed precourse knowledge and confidence assessments and reported barriers to resuscitation leadership. Fellows then led 2 simulated cases of cardiac arrest, initially developed for internal medicine residents with vignettes adapted to better reflect an NCC patient population. Postcourse knowledge and confidence assessments were administered immediately after the intervention and again one to 4 months later. Pre-, immediate post-, and delayed post-confidence and knowledge assessments were compared.

Results: Thirteen NCC fellows participated in the study. Limited experience leading a resuscitation and not being preassigned the resuscitation leader role were the most highly cited barriers to leading resuscitations (n = 8/13, 61.5%). Lack of confidence and lack of knowledge were barriers for 38.5% (n = 5/13) and 22.2% (n = 2/9) of participants, respectively. Both confidence and knowledge scores improved on the immediate postassessments (5-point Likert median [IQR] 3.5 [3.1-3.9] vs 4.1 [4.0-4.7], p = 0.005; mean [SD] 69.8% [8.8%] vs 88.5% [7.6%], p = 0.004). No confidence or knowledge decay was observed between the immediate and delayed postcourse assessments (4.1 [4.0-4.7] vs 4.1 [3.2-4.4], p = 0.50; 91.7% [6.8%] vs 81.3% [8.0%], p = 0.08).

Discussion: Shared simulation training improved learner confidence and knowledge in cardiac arrest resuscitation leadership and may yield similar benefits in other simulated scenarios. Low confidence, identified as a barrier to resuscitation leadership for over one-third of NCC fellows, was improved by brief simulation training.