Traditional Poster Round
Background: : Learning to function as a leader on an inter-professional code team is an important component of residency training (1). In our program, senior residents serve as hospital code team leaders on even calendar days, alternating with critical care fellows. In a baseline survey, residents cited a lack of confidence in their code leadership abilities as the reason they did not assume the role of code team leader. Therefore, we implemented a longitudinal simulation-based curriculum to improve resident self-confidence in their code team leadership skills.
Research Question: : Our primary research question is: does a formalized, longitudinal simulation-based curriculum improve resident self-confidence in their code team leadership skills. Our hypothesis was that residents would have improved confidence in their code team leadership skills after completion of the curriculum.
Methodology: : Preliminary needs assessment results indicated that residents do not assume the leadership role in codes because they lack confidence in four essential domains: ability to recognize critical patients, ability to manage critical patients, procedural skills, and leadership skills. These results guided the development of a high-fidelity mannequin-based simulation curriculum which included a mock code and a leadership skills workshop. Pre- and post-tests assessed the impact of the curriculum on resident self-confidence in those four domains.
Residents were assessed on 14 individual five-point Likert scale items (1=strongly disagree, 5=strongly agree) grouped into the four domains. Data was de-identified and unpaired between pre- and post-assessments. The individual item and domain scores were compared with Mann-Whitney U-tests and independent t-tests, respectively. Effect size was calculated with Cohen’s d. Inter-item reliability was assessed with Cronbach alpha.
Results: : Fifty residents completed assessments. Nine of the 14 individual items (64%) reported significant increases in median scores (all p≤.050), with the largest increases in leadership skills (delta=1.5, p<.001) and logistical abilities (delta=2.0, p<.001). There were statistically significant pre-post increases in resident confidence in their management (d=0.7, p<.001), procedural, (d=0.9, p<.001), and leadership skills (d=1.0, p<.001). No significant difference was seen for recognition of critical patients. The inter-item reliability for the 14 individual items was alpha=0.92.
Discussion/Conclusions: : Residents in our program are confident in their overall ability to assess critically ill patients. Resident participation in a simulation-based code team leadership curriculum is associated with improved self-confidence in their management, procedural, and leadership skills. Future results of the study will include assessing the impact of this improved self-confidence on residents’ ability to lead live patient code events.