Board #255 - Program Innovation Development, Implementation and Assessment of a Longitudinal Simulation Curriculum for the Management of Medical Emergencies: The RAPID Training Program (Submission #8139)

Objectives Responding appropriately to urgent or emergent situations is an essential skill for medical students to acquire during medical school. Most interns will encounter this situation early in their residency. Students should be equipped with the skills needed to respond in these critical situations where appropriate, timely intervention impacts patient outcomes. The era of patient safety and development of milestones in GME has reignited discussion regarding whether medical students possess the skills expected on day one of residency.1-5 The AAMC recently published its preliminary draft on Core Entrustable Professional Activities (EPAs), behaviors expected of all graduating medical students. One of the core EPAs is to recognize a patient requiring urgent or emergent care, initiate evaluation and treatment and seek help (EPA No. 10).6 Although students may take courses such as BLS and ACLS, or participate in transition courses, studies have demonstrated that without deliberate practice, repeated exposure, and feedback, these skills may not be retained.7-11 In addition, to make a decision that implies entrustment, a robust curriculum and assessment process must be in place. In an effort to ensure our students meet these expectations, a longitudinal simulation curriculum was developed. Description The RAPID (Responding Appropriately to a Patient In Distress) training program is a simulation-based curriculum that incorporates the critical components of EPA No. 10 and fosters progressive implementation and deliberate practice of these skills across all four years of training. Global objectives include the ability to recognize and respond to a patient in distress, communicate effectively, and engage and utilize team members effectively. To enhance communication training, an online learning module was developed. The module utilizes an adaptation of the SBAR (Situation, Background, Assessment, and Recommendation) framework and is viewed by learners prior to the simulation activities.12 Faculty aim to explore the hypothesis that repeated exposure through a longitudinal curriculum improves skills and retention by evaluating the following: 1) Validity and reliability of adapted assessment tools guided by Kirkpatrick’s hierarchy and Messick’s framework;13-16 2) Retention of knowledge and skills throughout the four year medical school experience; and 3) Overall performance before and after program implementation. Data collection methods will include video recordings, checklists, and online survey and database software. Analysis will be conducted within and between student cohorts. Conclusion To address the need for a longitudinal approach to residency preparedness our faculty developed the RAPID program. Preparing future doctors for emergency situations is crucial to improving patient safety outcomes.17 The importance of these skills is highlighted by efforts such as the ACGME Milestone Project and the recent AAMC Core Entrustable Professional Activities.6,18-20 Our innovative RAPID curriculum provides learners with a methodical approach that specifies objectives for each level of training and continues to build and reinforce these skills each year. Several studies have reported efforts to incorporate simulation-based emergent care training into the initial basic science year.7-8 However, to our knowledge, no data are available on the effectiveness of a longitudinal simulation-based emergent care course spanning the four years of undergraduate medical training. Research is needed on the effectiveness and retention of these skills within the standard curriculum. The RAPID training program will provide data on the success of such a program and will initiate a process to assess entrustment of these critical competencies prior to starting residency. References 1. Hall K, Schneider B, Abercrombie S, Gravel Jr. J, Hoekzema G, Kozakowski S, Mazzone M, Shaffer T, Wieschaus M. Hitting the ground running: medical student preparedness for residency training. Ann of Fam Med 2011;9:375. 2. Dickson GM, Chesser AK, Woods NK, Krug NR, Kellerman RD. Family medicine residency program director expectations of procedural skills of medical school graduates. Fam Med 2013;45:392-399. 3. Lypson ML, Frohna JG, Gruppen LD, Wooliscroft JO. Assessing residents’ competencies at baseline: identifying the gaps. Acad Med 2004;79:564-570. 4. Raymond MR, Mee J, King A, Haist S, Winward ML. What new residents do during their initial months of training. Acad Med 2011;86:S59-S62. 5. McEvoy MD, DeWaay DJ, Vanderbilt A, Alexander LA, Stilley MC, Hedge MC, Kern DH. Are fourth-year medical students as prepared to manage unstable patients as they are to manage stable patients? Acad Med 2014;89:618-624. 6. Englander R. Core Entrustable Professional Activities for Entering Residency. Available at: https://www.mededportal.org/icollaborative/resource/887. Accessed February 2, 2014. 7. Rogers PL, Jacob H, Thomas EA, Harwell M, Willenkin RL, Pinsky MR. Medical students can learn the basic application, analytic, evaluative, and psychomotor skills of critical care medicine. Crit Care Med 2000;28:550-554. 8. Smith CM, Perkins GD, Bullock I, Bion JF. Undergraduate training in the care of the acutely ill patient: a literature review. Intensive Care Med 2007;33:901-907. 9. Hamilton R. Nurses’ knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature. J Adv Nurs 2005;51:288-297. 10. Hazinski MF. Highlights of the 2010 American Heart Association Guidelines for CPR and ECC. Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf. Accessed February 2, 2014. 11. Smith KK, Gilcreast D, Pierce K. Evaluation of staff’s retention of ACLS and BLS skills. Resuscitation 2008;78:59-65. 12. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13:i85-i90. 13. Kirkpatrick DL, Kirkpatrick JD. Evaluating Training Programs: The Four Levels. San Francisco, CA: Berrett-Koehler Publishers, Inc.; 2006. 14. Kirkpatrick DL, Kirkpatrick JD. Implementing the Four Levels: A Practical Guide for Effective Evaluation of Training Programs. San Francisco, CA: Berrett-Koehler Publishers, Inc.; 2007. 15. Messick S. Validity of psychological assessment: Validation of inferences from persons’ responses and performances as scientific inquiry into score meaning. American Psychologist 1995;50:741-749. 16. Messick S. Test Validity: A Matter of Consequence. Social Indicators Research 1998;45,35-44. 17. Association of American Medical Colleges. Teaching for Quality: Integrating Quality Improvement and Patient Safety Across the Continuum of Medical Education. Available at: https://www.aamc.org/initiatives/cei/te4q/. Accessed October 20, 2013. 18. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system–rationale and benefits. N Engl J Med 2012;366:1051-1056. 19. Carraccio C, Burke A.E Beyond competencies and milestones: adding meaning through context. J Grad Med Educ 2010;2:419-422. 20. Green ML, Aagaard EM, Caverzagie KJ, Chick DA, Holmboe E, Kane G, Smith CD, Iobst W. Charting the road to competence: developmental milestones for internal medicine residency training. J Grad Med Educ 2009;1:5-20. Disclosures None