A NOVEL SIMULATION BASED EDUCATIONAL CURRICULUM TO IMPROVE INTERNAL MEDICINE RESIDENT MANAGEMENT OF POST-CARDIAC SURGERY PATIENTS FOLLOWING CARDIAC ARREST

SESSION TITLE: Nurturing Growth: Fostering Success in Trainees SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2023 01:45 pm - 02:45 pm PURPOSE: The incidence of cardiac arrest following adult cardiac surgery is 0.7 - 8%, and the survival rate remains remarkably high (79%). This impressive survival rate has been partly attributed to a high incidence of reversible causes of cardiac arrests in this population. The Society of Thoracic Surgery (STS) expert consensus has published a protocol to address these reversible causes, which deviates from the American Heart Association’s ACLS algorithm. Although the protocol has become the standard of care for managing cardiac arrests in post-cardiac surgery patients, it is not traditionally included in internal medicine (IM) residency training. Mount Sinai Morningside is a center for cardiac surgery where IM residents are first responders to in-hospital cardiac arrests and may resuscitate a post-cardiac surgery patient. The goal of this project was to evaluate and improve residents’ knowledge, comfort, and skill in managing cardiac arrest in this specific patient population. METHODS: A simulation training case was developed to address the resuscitation of patients who arrest after cardiac surgery based on the STS protocol. Pre- and post-simulation surveys were developed to evaluate residents’ knowledge and comfort in managing this specific population. The surveys and simulation case were approved by the Center for Advanced Medical Simulation team. The case was integrated into PGY2 and PGY3 IM resident ACLS Simulation Sessions from 7/2022 - 9/2022. A chi-squared test was utilized to analyze improvement in resident comfort level in resuscitating post cardiac-surgery patients and ability to identify a difference in resuscitation of this population. A paired sample t-test and Mann-Whitney U test were utilized to analyze differences in knowledge between pre- and post-simulation surveys RESULTS: A total of 75 IM residents participated in the simulation. 88% of residents reported they have never received training in resuscitating a post-cardiac surgery patient and only 4% felt comfortable resuscitating this population. Compared to the pre-simulation survey, there was a 29% improvement in recognizing differences in cardiac resuscitation between post-cardiac surgery patients and standard ACLS (p<0.001); a 63% improvement in comfort resuscitating this population (p<0.001); and a significant improvement in knowledge of the protocol (pre-simulation mean 2.27 [1.1], median [1,3]; post-simulation mean 3.8[1], median 4[3,4], p<0.001) after the training session. CONCLUSIONS: This simulation training session resulted in a statistically significant improvement in residents’ ability to recognize differences in managing a post-cardiac surgery cardiac arrest, comfort level in resuscitating this population, and knowledge regarding the STS protocol. CLINICAL IMPLICATIONS: High fidelity simulation can be an effective training modality to improve knowledge and skills among healthcare providers and improve clinical care. DISCLOSURES: No relevant relationships by Susannah Kurtz No relevant relationships by Priscilla Loanzon No relevant relationships by Joseph Mathew No relevant relationships by James Salonia No relevant relationships by Harrindra Seepersaud No relevant relationships by Barbara Sierra No relevant relationships by Elizabeth Zipf