AHA QCOR 2017 Abstract submission Category: Cardiac Arrest/CPR
“How well can you run a code?” Assessing resident comfort and competence with in-hospital cardiac arrest
Background: Despite their frequent role in caring for patients with in-hospital cardiac arrest (IHCA), earlier data suggest residents often feel uncomfortable during resuscitations. We sought to characterize the experiences of residents at our academic institution with IHCA, delineate reasons for discomfort (if any) with their roles, and then assess what educational interventions were considered most valuable.
Methods: We performed a 9-question survey that was electronically distributed to all internal medicine and medicine-pediatrics residents at the University of Michigan Health System. This survey asked residents about: 1) the number of IHCAs that residents had attended or led, 2) their comfort with their roles including leading an IHCA, 3) possible reasons for any discomfort in their roles, and 4) educational interventions that would be considered favorable. We report simple unadjusted statistics.
Results: We received 100 responses from 155 residents, a 64.5% yield. Most PGY-1s and 2s reported being to few or no IHCAs (n=47/69, 68%) and that some PGY-3s and 4s had never run a resuscitation effort (n=4/31, 13%). Regardless of level of training, few residents rated their ability to run a resuscitation effort as very good or excellent (n=8, 8%). Most residents were unsatisfied with the formal education currently in place for IHCAs (ACLS training, code refresher sessions for residents on general medicine or cardiology) (n=62, 62%). The majority of residents had rarely or never given (n=72, 72%)/received feedback (n=68, 68%). Of the possible educational interventions presented as options, the most popular that were perceived among residents were debriefing with the attending physician and other residents (n=66, 66%), and debriefing in a multidisciplinary setting (n=59, 59%).
Conclusion: We characterized the experience of internal medicine and medicine-pediatrics residents with leading IHCAs at our academic institution. We found few residents perceived their own comfort and competence as adequate. These findings provide a foundation for future efforts to potentially elevate resident performance in IHCA.