In-situ Simulation-Based Module to Train Interns in Resuscitation Skills During Cardiac Arrest

Purpose: Competency to perform cardiopulmonary resuscitation is essential to improve the outcome during an event of cardiac arrest. Medical internship is a "transition phase" beyond which physicians are exposed to the unpreparedness and anxiety while dealing with life-threatening conditions which need rapid actions. Experiential learning, deliberate practice and immediate feedback are the primary advantages of simulation-based medical education. In-situ simulation occurs in a real patient care environment utilizing the available resources. Our aim was to introduce in-situ simulation-based resuscitation skills training for medical interns. Methodology: This was a prospective quasi-experimental study with mixed research design conducted in the emergency department. The knowledge score questionnaire, skill-score sheet, post-simulation feedback from the interns and staff were designed, validated through experts, peer-reviewed and pilot tested. All the interns posted in the emergency department participated in the training. Appropriate statistical analyses were applied for quantitative data. Thematic analysis of the data from the open-ended questions was used to identify the themes. Results: Six groups of interns (n=35) participated in at least one of the 40 in-situ simulation sessions. The means of the pre- and post-simulation knowledge scores were 5.89 +/- 2.8 SD and 11.74 +/- 1.8 SD, respectively, and the difference was statistically significant [t (35) = 16.705, p<0.001]. The skill score had a positive correlation (Pearson correlation coefficient r=0.985, p=0.01) with the number of simulations performed in each group. The thematic analysis uncovered the themes related to the simulation methodology, reflective learning, enhancement of the non-technical skills and effective feedback. The self-reported enhancement in teamwork skills and the confidence level was significant. The feedback of the staff in the Emergency Department showed a positive attitude towards in-situ simulation. Conclusion: This study demonstrated an increase in the knowledge and skills of the interns after participation in the in-situ simulation sessions. Based on the results, the study recommends that in-situ simulation-based teaching should be incorporated in the existing medical education system.