In their paper, "Emergency Medicine Simulation: A Resident's Perspective", Drs. Meguerdichian, Heiner, and Younggren describe a new resident stepping into an emergency department (ED), immediately confronted by the commotion of a team trying to save a patient who has begun to code. The new resident quickly determines that the patient needs to be intubated. The airway proves to be difficult, and with every step the new intern takes, first using a Macintosh blade, then a video laryngoscope, the patient deteriorates one step ahead. Alarms blaring, and sweat building up on his brow, the new intern prepares to perform a cricothyroidotomy. With that decision, the alarms halt, and the new intern is commended for his efforts. The case was a simulation, part of what all three doctors encourage as part of an onboarding process for new residents.16
This type of situation, a low frequency, high acuity event, can be especially problematic for a new intern given the infrequency of true hands-on practice.17
70% of sentinel events reported to the Joint Commission have been found traceable to communication failure as the primary root cause.18 Additionally, 80% of patient harm is traceable to a breakdown in teamwork and communication during patient hand-offs.19 Simulation can help.
Three leading indicators of good patient-centered performance are:
1. Staff Confidence
Yet, interns can reportedly feel paralyzed in the first year of their residency program as they adjust to the change in their environment and an awareness of how much there is to learn. "I spent much of [my first year] in a state of crisis and doubt," says Dr. Sandeep Jahuar, author of the memoir Intern.20
Incorporating simulation in your program will not only benefit the new interns but will give attending physicians a chance to gauge resident confidence, competency and compliance with hospital regulations, their new environment, and their new teams – all while protecting the patient.