Emergency in the clinic: a simulation curriculum to improve outpatient safety.

Abstract

BACKGROUND:

Emergency response skills are essential when events such as seizure, anaphylaxis, or hemorrhage occur in the outpatient setting. As services and procedures increasingly move outside the hospital, training to manage complications may improve outcomes.

OBJECTIVE:

The objective of this study was to evaluate a simulation-based curriculum in outpatient emergency management skills with the outcome measures of graded objective performance and learner self-efficacy.

STUDY DESIGN:

This pre- and postcurriculum study enrolled residents and fellows in Obstetrics and Gynecology and Family Medicine in a simulation-based, outpatient emergency management curriculum. Learners completed self-efficacy questionnaires and were videotaped managing 3 medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest, and hemorrhage) in the simulation laboratory both before and after completion of the curriculum. Evaluators who were blinded to training level scored the simulation performance videotapes using a graded rubric with critical action checklists. Scenario scores were assigned in 5 domains and globally. Paired t-tests were used to determine differences pre- and postcurriculum.

RESULTS:

Thirty residents completed the curriculum and pre- and postcurriculum testing. Subjects' objective performance scores improved in all 5 domains (P<.05) in all scenarios. When scores were stratified by level of training, all participants demonstrated global improvement. When scores were stratified by previous outpatient simulation experience, subjects with previous experience improved in all but management of excess sedation. Pre- and postcurriculum self-efficacy evaluations demonstrated improvement in all 7 measured areas: confidence, use of appropriate resources, communication skills, complex airway management, bag mask ventilation, resuscitation, and hemorrhage management. Self-efficacy assessment showed improvement in confidence managing outpatient emergencies (P=.001) and ability to communicate well in emergency situations (P<.001).

CONCLUSION:

A simulation-based curriculum improved both self-efficacy and objectively rated performance scores in management of outpatient medical emergencies. Simulation-based curricula should be incorporated into residency education.

• Authors: Eve Espey, Gillian Baty, John Rask, Michelle Chungtuyco, Brenda Pereda, Lawrence Leeman
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 217 Issue 6 Pg. 699.e1-699.e13 (12 2017) ISSN: 1097-6868 [Electronic] United States
• PMID: 28919404 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Ambulatory Care
• Cardiopulmonary Resuscitation
• Communication
• Curriculum
• Disease Management
• Education, Medical, Graduate
• Emergencies
• Family Practice (education)
• Female
• Gynecology (education)
• Heart Arrest (therapy)
• Hemorrhage (therapy)
• Humans
• Internship and Residency
• Male
• Obstetrics (education)
• Patient Care Team
• Patient Safety
• Pregnancy
• Respiration, Artificial
• Resuscitation
• Seizures (therapy)
• Self Efficacy
• Simulation Training