Training junior doctors to lead rapid responses

Abstract

BackgroundTransitions 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.ApproachIn 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.EvaluationForty‐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.ImplicationsThough 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.

Educational Interventions for Rapid Response Team Members

“…Three of the studies employed 1-group pretest-posttest, quasi-experimental research designs, whereas one of the studies used a 1-group posttest-only, quasi-experimental research design, which did not use a control group. [22][23][24][25] Two studies used a prospective cohort design to assess outcomes from educational interventions. 26,27 Participants receiving educational interventions included medical residents (n = 3 studies), [22][23][24] nurse practitioners (n = 2 studies), 24,25 fellows (n = 1 studies), 25 and bedside nurses (n = 4 studies).…”

“…[22][23][24][25] Two studies used a prospective cohort design to assess outcomes from educational interventions. 26,27 Participants receiving educational interventions included medical residents (n = 3 studies), [22][23][24] nurse practitioners (n = 2 studies), 24,25 fellows (n = 1 studies), 25 and bedside nurses (n = 4 studies). [24][25][26][27] Four of the studies were conducted in the United States, [22][23][24][25] and 2 were conducted in the United Kingdom.…”

“…26,27 Participants receiving educational interventions included medical residents (n = 3 studies), [22][23][24] nurse practitioners (n = 2 studies), 24,25 fellows (n = 1 studies), 25 and bedside nurses (n = 4 studies). [24][25][26][27] Four of the studies were conducted in the United States, [22][23][24][25] and 2 were conducted in the United Kingdom. [25][26][27] Three of the studies focus specifically on pediatric health care providers, [25][26][27] 2 focused on adult health care providers, 23,24 and 1 study had participants with training in both pediatric and adult health care.…”

“…[24][25][26][27] Four of the studies were conducted in the United States, [22][23][24][25] and 2 were conducted in the United Kingdom. [25][26][27] Three of the studies focus specifically on pediatric health care providers, [25][26][27] 2 focused on adult health care providers, 23,24 and 1 study had participants with training in both pediatric and adult health care. 22 The educational interventions varied across the studies, with some studies using multiple forms of educational intervention methods.…”

From doing to leading: PGY‐1 to PGY‐2 transition

“…Several resident suggestions have been implemented in our department. The transitions curriculum now consists of three segments: a half-day retreat focusing on team leadership and managing the day; a simulation-based curriculum to lead clinical emergencies 17 ; and a half-day teaching skills retreat in early PGY-2 year. Though this longitudinal approach was rated highly on resident surveys, it needs to be systematically evaluated and more research is needed to determine the real-life impact of such training.…”