Training junior doctors to lead rapid responses

Link to article at PubMed

Clin Teach. 2021 Oct 19. doi: 10.1111/tct.13426. Online ahead of print.


BACKGROUND: Transitions during medical training are a significant source of stress, and junior doctors (residents) primarily learn new skills through on-the-job training. As residents transition from postgraduate year (PGY) 1 to 2, they take on new responsibilities, including the management of clinically unstable patients in rapid response (RR) scenarios.

APPROACH: In 2018, the internal medicine training programme at Brigham and Women's Hospital implemented a 'Transitions Retreat' to prepare PGY-1s for Year 2. In an informal survey, residents endorsed feeling underprepared to lead RRs. We designed a simulation-based curriculum to teach these skills. Participants completed a questionnaire pre-simulation and post-simulation exploring their perceived preparedness. Volunteer residents assessed performance on the simulation using skills checklists and led structured debriefing sessions. We audiotaped, transcribed and thematically analysed these sessions.

EVALUATION: Forty-eight of 58 (82%) PGY-1s participated. Pre-intervention, 12.5% felt 'well-prepared' or 'very well-prepared' to lead RRs, compared with 33% post-intervention. Through qualitative analysis, we identified four key themes in our post-simulation debriefing conversations: (1) the chaos of RRs, (2) emotional reactions during RRs, (3) challenges and goals of task management and (4) value of interdisciplinary collaboration.

IMPLICATIONS: Though the majority of residents indicated that the curriculum enabled their preparedness to lead RRs and allowed them to process complex emotions in a safe space, we do not know how well this experience translates to the clinical setting. Therefore, we aim to collect follow-up data 6 months into the PGY-2 to explore residents' reflections on real-life experiences as well as whether the simulation impacted their preparedness to lead real-life RRs.

PMID:34668319 | DOI:10.1111/tct.13426

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