Johnkutty Meenu, Kuperstein Harry, Koroma Fatima, Chen Jessi, Mattson James, Ahmad Sahar
Medical Student, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
Faculty, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
Med Educ Online. 2025 Dec;30(1):2528355. doi: 10.1080/10872981.2025.2528355. Epub 2025 Jul 3.
Simulation training aims to increase exposure to high-stakes low-frequency events like cardiac arrest. However, within our laboratory-based simulation program, we have observed limited buy-in from internal medicine (IM) residents due to competing patient care obligations and a limited fidelity environment. Mirroring patient data within simulation may provide relevance to ongoing resident patient care obligations, increasing buy-in and confidence in management. Clinical data from presently admitted patients in our institution's medical intensive care unit (MICU) was 'mirrored' to create cardiac arrest simulations. Simulations took place in a vacant MICU patient room with resuscitation equipment, including a code cart, saline-substituted medications, and a mannequin capable of endotracheal intubation. The trainee team consisted of one post-graduate year (PGY) 3 IM resident, two PGY-1 residents, and a critical care fellow. A pre- and post-survey was administered to the PGY-3 IM resident to assess confidence in performing technical and non-technical skills. An advanced cardiac life support (ACLS) instructor evaluated PGY-3 IM resident performance using a skills checklist. Eighty-three percent of PGY 3 residents endorsed changes to their practice following the simulation. Confidence increased in skills related to flexible decision-making skills but not for fixed skills such as following ACLS protocol. Qualitative feedback highlighted realism, spontaneity, and debriefing sessions as the most valuable aspects of the program. mirror simulation may be a useful adjunct for IM residency programs suffering similar concerns with learner motivation during laboratory simulation.
模拟训练旨在增加对心脏骤停等高风险低频事件的接触。然而，在我们基于实验室的模拟项目中，由于内科住院医师有相互冲突的患者护理义务以及模拟环境的逼真度有限，我们观察到他们的参与度不高。在模拟中镜像患者数据可能会使住院医师与当前的患者护理义务相关联，从而提高参与度和管理信心。我们将本机构医学重症监护病房（MICU）目前收治患者的临床数据进行“镜像”处理，以创建心脏骤停模拟场景。模拟在一间空置的MICU病房进行，配备了复苏设备，包括急救推车、生理盐水替代药物以及一台能够进行气管插管的人体模型。学员团队由一名三年级内科住院医师、两名一年级住院医师和一名重症监护专科医师组成。对三年级内科住院医师进行了模拟前后的调查，以评估他们在执行技术和非技术技能方面的信心。一名高级心脏生命支持（ACLS）教员使用技能清单对三年级内科住院医师的表现进行评估。83%的三年级住院医师认可在模拟后对其临床实践进行改变。与灵活决策技能相关的信心有所增加，但遵循ACLS协议等固定技能方面的信心没有增加。定性反馈强调逼真性、自发性和总结会议是该项目最有价值的方面。镜像模拟对于在实验室模拟期间同样存在学员积极性问题的内科住院医师培训项目可能是一种有用的辅助手段。
