Good afternoon, everyone, and let's go. So yeah, thank you for the invitation to speak here today. On behalf of my fellows here, my former fellows, I'm Deepak Pradhan. I'm an associate professor at New York University. And of note, this research is actually funded through a premier medical education grant. So today, I'm going to talk to you about designing a longitudinal POCUS curriculum for novice attendings, in this case, practicing pulmonologists, applying four-component instructional design for CID model in designing a longitudinal curriculum, and illustrating the use of using trainees as true educators, not just as teachers. So what's the problem? Well, point-of-care ultrasound is an emerging technology where a lot of faculty learner groups feel like they've been left behind, and that negatively impacts trainee education. So how do we educate faculty in point-of-care ultrasound? Well, we can do it nationally in courses, but that's pretty expensive. There's also it's a primary course, and there's degradation of skill over time. So how do we teach them locally and longitudinally, particularly when we have limited teaching resources at any of our institutions? So second problem is that trainees are increasingly being taught to perform point-of-care ultrasound, yet there's not much in the way of really good assessment methodology across the board, and this includes even in pulmonary critical care medicine. And so there are also no courses in literature regarding training trainees to be teachers of point-of-care ultrasound. Just because you're, you know, competent to perform it does not mean that you're excellent at teaching it, nor any formal assessments of folks' teaching ability. So I decided to proverbially kill two birds with one stone, and I have my senior pulmonary critical care fellows who are competent in point-of-care ultrasound through competency assessments, and they teach to faculty who are not yet competent in point-of-care ultrasound via longitudinal course. I'm very immature, so I call us fellows as teachers of ultrasound course, and my fellows have like T-shirts. So this is actually not just a pragmatic solution. This is also seeped in with a lot of educational theory underlying it. This is of near-peer education. So my fellows are near-peer teachers to those senior attending learners of reverse educational distance, and the benefits to them are they get a second bite of the apple to relearn prior information, they improve upon their teaching skills, and we give them feedback, and then they're motivated to do well, and they also develop, you know, the idea of being a teacher, being an educator, so these professional identity development. So how do we create a longitudinal-focused course specifically for pulmonologists? So start out with a literature search, you know, why reinvent the wheel? Unfortunately, the wheel has not been invented in this area, and there's not really courses like that, so can't do it that way, but, you know, still, it gives you some expert opinion on what should be in that curriculum. I also did a needs assessment of that potential learner class to see what their deficits are, and then also I did a broader stakeholder analysis to look at just not just the fellow teachers and then the attending learners, but what about divisional leadership, program leadership, institutional leadership, what about governing bodies and community and so forth, what do they want the pulmonologist to be able to do when it comes to point-of-care ultrasound? And so we came up with this seven-month course that we call POCUS for Pulmonologists, P for P, and the idea is that it starts out with basic ultrasound and vascular ultrasound. The following month, it moves into basic lung pleural ultrasound, then it goes into the inpatient setting, where then it's real curated patients with real pathology. Then we come back to the simulation setting the following month for transthoracic echo, and the following month we go, again, curated cardiac patients with real pathology. Then we come the following month with using ultrasound for acute respiratory failure, which is a combination of really all those skills that they've now picked up over time, and we finish with diaphragmatic ultrasound. And the key here is that there's pre-stuff, there's the sessions, and then there's post-stuff and homework as well, so this moves longitudinally through this. The peach-colored sessions are fellow-designed and taught. So what does that mean by fellow-designed? They're not just showing up and then teaching. They're going to design the whole sessions lock, stock, and barrel. They do this through, they meet with me prior, the month prior, and I give them a primer on Marenboer's four-component instructional design model, which goes over learning tasks, supportive information, procedural information, and part task practice. So they have to actually think about what is it that a pulmonologist should be able to do with point-of-care ultrasound. They have to think about the curated materials they're going to use, just-in-time materials, and then, you know, what things they want to, how they want to structure those sessions. Then, so this is a sample of what it might look like. So this is lung pleural ultrasound on SPs and task trainers for session number two. We do this in the simulation center. Only one type of ultrasound machine used, so we decreased the amount of extraneous cognitive load. The first task is ruling out pneumothorax, so these are authentic whole tasks. This isn't put a probe on and see if you can find A-lines, show me sliding lung. Those are incomplete tasks. That's not a real task that anybody actually does in real life. It's better if you say, the 60-year-old male who just came in, who's got moderate COPD with atypical chest pain and shortness of breath, and can you use ultrasound to rule in or rule out a pneumothorax on their right side? That is an authentic, real-world task. That's number one. The second task they do is ruling out a pleural effusion, so going from high-frequency probe to a low-frequency phased-array probe, and they have to know peridiophragmatic structures. Then learning the third one is identify a safe location for thoracentesis. So again, now they're going to look dynamically at M-mode and look at changes between the visceral and parietal pleura dynamically. They also have to harken back to the prior lecture or series when they learned vascular ultrasound to identify intercostal arteries as well. So this is the way they've sequenced, so the fellows have decided what is it that a pulmonologist should be able to do. They have to sequence these learning tasks. They decide on what supportive information needs to be given ahead of time, the articles, the videos, so forth. Then procedural information, they're doing role modeling, coaching, and corrective feedback to those attending learners. They also are engaging in part-task practice, switching between high-frequency, low-frequency probes, optimizing depth, the gain, using M-mode, color Doppler. So these are the types of things that's going to create automaticity, repetitiveness, so it's less intrinsic cognitive load used on that for the learners. So the other thing is that since this is a nurturing session, the fellows also, so I sit in the back of the room as they deliver this session, and then I use this rubric here, which is adapted from our NYU's Education for Educators program, and so I can use this as a checklist tool, as well as looking at what aspects they did well and what aspects there are opportunities for change. And then immediately after the sessions, I provide them with that formative feedback so that it improves their teaching practice going forward. And again, I'm not showing the data, but they very much enjoy that and grow from that experience. So how do we look at the success of this P4P program? So pre- and post-course learners completed multiple-choice testing, confidence surveys, as well as three behaviorally anchored OSCEs that have some amount of validity evidence behind them. So what are our results? Well, so now there are eight of my senior pulmonary critical care fellows who ultimately taught 10 pulmonary attendings, and these attendings were about 15 years out of their training phase. They're generally, they see themselves as novices in point-of-care ultrasound. And so pre-course, in terms of multiple-choice testing, they scored about 50% on their testing. After the seven months, they are now answering about three-fourths of the questions correctly. So you know, they've gained some knowledge in point-of-care ultrasound. In terms of their confidence levels, you see that they start out kind of low levels, generally around two-ish, and so, which is not very confident, or even in areas like Blue Protocol at a one, no confidence whatsoever. And at the end of the course, they're really at more three-to-four levels, so moderate confidence to very confident in doing this activity, so that's a nice increase. Again, this is more, if you go Kirkpatrick programmatic evaluation, this is kind of level two in terms of learning. And then we also use OSCEs in terms of, for pleural fusion, qualitatively LV functionality, as well as Blue Protocol acute respiratory failure. And you see the pre-course median for the group, they're answering about 57% of those checklist items, you know, initially when they started, which is not surprising. They are pulmonologists, after all, they can do something. Maybe it's scarier that they are 43% of the items they're missing. And they really can't do transthoracic echo, or put it all together for acute respiratory failure. Afterwards, they're able to do these OSCEs, as you can see, quite consistently across the board. So they really did gain that. So it's now going from a knowledge, cognitive place, to a more psychomotor, and being able to put it into action, so image acquisition skills as well. So again, these are all Kirkpatrick two. And then we kind of go from there to, we have some institutional-focused credentialing that started this past year. And three out of the 10 learners now have created their thoracic portfolios to meet credentialing requirements. And so this is now getting into Kirkpatrick three and four, which is more about their behaviors, and then also results. So take-home points. One, creation of a longitudinal curriculum can be systematically, should be systematically designed using literature searches, needs assessment, and stakeholder analysis. Four-component instructional design model can be utilized to thoughtfully structure a longitudinal curriculum, to teach complex skills. And lastly, trainees are pretty amazing. They can be used not just as teachers, but also as educationalists, right? If you mentor them, that's the key part, they can actually design their own end sessions and deliver them as well. Here are my references. Here are my fellows, the whole top row, they graduated, and now they are, they stayed on at NYU. And the bottom row, Ariella is over at Intensivism Canada, H.D.'s at West Virginia University as faculty, and Brooke is at the University of Pennsylvania. And with that, mahalo. I'm Jane Penguin. I'm a third-year internal medicine resident at Ascension St. Vincent's in Indianapolis, and I'm here to talk about a monthly wellness support group that we created for our residents in the ICO. All right, so just a little bit of background about how this kind of started. We first initiated this in the peak of the Omicron surge. At Ascension St. Vincent, ICU residents at the time were taking part in almost up to four comfort care planning discussions per day. About 50% of all of our extubations in the MICU were resulting in terminal weans, which is probably pretty similar to a lot of programs at this time. Our program at that time had no easily accessible method to help kind of process the significant emotional burden for residents, and in general, it's pretty difficult for residents to find time in their schedule for formal counseling. It also can be pretty expensive. Obviously, there are high rates of burnout during residency. There's significant burnout after residency. The coping mechanisms or lack of learned in residency do carry over. Residency nationally have wellness programs for sleep, fitness, mindfulness, socialization, et cetera, but typically, these events take place outside of work hours, which cuts into residents already limited time away from the hospital, and there's also seems to be less emphasis on kind of debriefing or emotional well-being in general. In the literature, there are very, very few studies currently on improving resident wellness within the complexities of the resident's schedule, and then just the effectiveness of these programs in general. So we developed a monthly recurring faculty-free, time-protected group session during work hours for residents to kind of discuss events, situations, feelings related to their time in the ICU. We have a trained facilitator who aids in directing these conversations. Essentially, it starts as residents kind of pick photos that kind of act as an allegorical kind of tool to kind of connect to how they're feeling at that time, and we kind of use this as a springboard to lead the discussion. These discussions normally last about a half hour or so, and then we've collected feedback from our residents to continue to improve future sessions. So we have about 25 survey results so far, which is about a fourth of our internal medicine program, and part of the results were asked kind of like, what was the reason that you chose to share your experiences today? Most respondents wished to hear other participants' perspectives, or they wanted help in processing a difficult experience. After the discussion, the majority of respondents felt that they noted that they felt more connected to their fellow residents or interns. They felt more comfortable sharing difficult situations, and they felt that they were able to provide better patient care moving forward, and all of the participants responded that they would recommend other residents to participate in this discussion as well. And I include some comments. They're pretty subjective, but I think it does show kind of how meaningful this was to our residents. Some things that were stated was sometimes we forget to reflect on what we've accomplished, and it's a nice reminder to do so. Someone else said, I feel like as residents, we are always expected to do more, be better, even when we are trying our hardest. This session was a good reminder that I need to take care of myself and that what I do as a resident matters. And thirdly, it helps us relate to each other and reminds us that we are all human. So kind of in summary, after participating in this event, the majority of residents felt less alone, more willing to participate in similar debriefing sessions in the future, and then better prepared to take care of patients. It is important for faculty to be willing to create protected time for wellness. Pretty much every program has protected time for didactics and learning, but not so much for emotional well-being and debriefing in general. And then obviously limitations. It's a very small sample size. We would like to see similar sessions within other internal medicine programs, other resident's specialties, fellows, attendings, et cetera. And then as we are now post-pandemic, are the needs of residents going to change moving forward? So in conclusion, you know, residents are tasked with a tough role as frontline care providers and residency-sponsored wellness programs that provide a space for discussion using narrative processing definitely has potential to improve resident well-being and reduce resident burnout in the future. That is all I have. Thank you. Okay. Thank you everyone for attending this session. My name is Mahmoud Alwakeel. I'm a second-year critical care fellow in Cleveland Clinic, and I have no disclosure. So I believe, like Jane, thank you for presenting your study because her study like highlighted about the wellness behind like our tough time during the COVID as a trainee, residents, and fellows. And everyone, unfortunately, not only in this room or as a trainee, the world has been affected. But the question I wish one time we ask ourselves, did it really like affected our performance as an academic performance? Have we read more so we had more knowledge or we didn't see the regular ICU cases so our knowledge like went even below the average? So as Jane presented, like there is multiple of like surveys have been conducted about wellness, but nothing about the academic performance, especially no one used a validated tool or a validated survey. And most likely, like most of you know, like the in-training exam has been validated multiple of times about the academic performance. So our objective, why we don't utilize this in-training exam to see if really COVID have impacted our academic performance or not. So this came as an our objective for our study. So the methodology, like it was simple one, like a retrospective study in our Cleveland Clinic training program. We divided our cohort to two cohorts, the pre-pandemic from 2016 to 2019, and the pandemic cohort from 2021 to 2022. We excluded 2020 because it was in the beginning of the pandemic. So we felt it's going to be a bias factor if we add it in our analysis, because if it really have been like impacted by COVID or not, like it wasn't going to be clear. We used just a simple student t-test. I'm going to comment at the end about the limitation of our study. So from this visualization, the more important than looking for the absolute percentage difference between the two cohorts, in the red color, you have the COVID cohort. And in the blue color, it is the pre-pandemic cohort. And this is the average of a score in the critical care and pulmonary exam. So the left four columns representing the critical care exam, the critical care people just taking the critical care exam, the pulmonary critical care fellows taking the exam divided to critical care and pulmonology. So we separated them to be including the critical care exam, and the pulmonology exam is separated in the last three columns. I want you to notice like the difference between the red pandemic and the pre-pandemic in the blue, like how significantly like there is some science telling us there is a difference. The percentage like going from 4% to 10% in some of the years, especially in the second year, like showing us like there is some science, there is a difference in our performance. But it is important to notice like this was 60 fellow before the pandemic versus 30 fellow after the pandemic. So our sample size is relatively low, and the type one of error is becoming like higher chance to achieve it. For that reason, like we have reached out to the board people, and we shared with them our result, and they were thankfully like very interested to study the effect on national level. And in the coming one week, we are going to receive the data to analyze it and see it in a bigger perspective on national level to see if the signal is going to be retained. And if it's going to be retained, is it related to some subsection in our exam, like are we scoring high in the pulmonology because we did with the COVID, but we are underscoring in the other subsection or not. So the conclusion, there is a signal like there is a difference has been happening during the COVID and our performance decreased, especially in the second year, because maybe our most of our training during the time was virtual and was affected mainly by COVID, it's difficult to know why for sure, but hopefully we can address it in the national level. The clinical implication, like it is important for the programs to realize, as Jane mentioned, like the wellness has been affected, but also the academic performance could be affected and every program has to study it like internally and try to have some plan for the future if God forbid similar pandemics happen. Thank you. Thank you all so much for participating in this oral slide presentation session. So the title of my presentation is medicine is a team sport, understanding team dynamics and culture of safety using video reflexive ethnography during real time emerging intubations. I am Dr. Garcia from the Mayo Clinic in Rochester, where I trained in emergency medicine and I'm currently a fellow in critical care. I plan to share with you how we used video reflexive ethnography to identify key safety gaps in the intubation process and discuss solutions proposed by our multidisciplinary intubation team. So, endotracheal intubation is the third most common procedure performed across U.S. hospitals, and its incidence is increasing. We all know how life-saving this procedure can be, but everyone in this room is also intimately aware of the dangerous complications associated with emergent endotracheal intubations. Specifically, the complications that can occur are hypotension, hypoxia, cardiac arrest, and even death. There are some studies that report a complication rate of over 40%, while other studies suggest that these complications are largely preventable and attributable to human factors. Many prior investigations have focused on addressing this major issue, but have largely focused primarily solely on the proceduralist. But anyone who does and works in the ICU knows that, in reality, emergent endotracheal intubations are performed by an entire team. And there is evidence that suggests that a number of these complications are related to team failures, rather than just individual failures alone. So our study aimed to explore the complexity of team dynamics during emergent intubations in the ED and ICU settings. And in order to do this, we used a fascinating technique called video reflexive ethnography. And what we did was this. We video recorded real-time endotracheal intubations, and then we showed that footage to the care teams to stimulate reflection and discuss strengths and opportunities for improvement. We did this in the Mayo Clinic Rochester Emergency Department and Medical Intensive Care Unit. These videos were then shown to the team during virtual multidisciplinary reflexive sessions. Each session lasted for about an hour and a half and included respiratory therapists, nurses, pharmacists, advanced practitioners, and physicians. During each session, we showed short two-minute video clips, specifically focusing on footage showing safety-related actions and team dynamics. All video reflexive sessions were audio recorded and video transcribed for analysis, and then we reviewed those transcripts to identify recurring themes. In total, we had 78 multidisciplinary professionals participate in a total of eight multidisciplinary reflexive sessions. As demonstrated in these pie graphs, we had excellent representation from each discipline in both the ED and ICU. After using video reflexive ethnography, the major themes identified were the following. Pre-briefing and the central components thereof. Team dynamics with a special emphasis on communication, roles, and situational awareness. Safety with a focus on how to approach safety concerns during the procedure. And debriefing and the importance of doing so after every intubation. Focusing first on the pre-brief, the three essential components were number one, establishing a shared mental model. Number two, preparing the team, the equipment, and the medications. And number three, using an intubation checklist. All of this, which is already known, but what our study discovered was that the entire multidisciplinary team wants to engage with that checklist. And during video review, we noticed that this rarely occurs because each discipline has competing tasks. Often, the respiratory therapist is preparing the equipment while the nurse is drying up the medication and the proceduralist is off to the corner reading the intubation checklist to themselves. When in fact, the entire multidisciplinary team strongly advocated for strong engagement in the process to improve patient safety, they specifically recommended that the checklist be performed during a dedicated procedural pause because they want to actively listen for certain components. The respiratory therapist wants to actively engage in what the primary airway plan is, what the backup plan is, and so forth, and close the loop to ensure optimal safety and quality of care. Similarly, the nurse wants to actively hear the medication plan and participate in closed-loop communication and other forms of nonverbal communication to improve accuracy, which is crucial, and to improve safety during medication administration. These are just a few examples, but the main take-home point is this. Multidisciplinary teams require collaboration to establish multidisciplinary solutions to improve safety during these high-risk procedures. In terms of team dynamics, in addition to the use of callbacks and closed-loop communication, we identified the importance of rapidly establishing roles and the influence of positioning in terms of communication and situational awareness. In fact, in the emergency department, we learned that your position equals your role, which can dramatically improve team dynamics and communication, especially in scenarios where the team has never worked together before. By where you stand, your role becomes implicit, communication is facilitated, and your position is deliberate to optimize situational awareness by providing a direct line of sight between you, the patient, the monitor, and the rest of your team. The third and maybe most important theme was importance of establishing a culture of safety. We must empower people to speak up when safety concerns are identified, and we must equally establish a culture where we address safety concerns respectfully and acknowledge them. Specifically, participants noted that the use of standardized terminology and communication tools, such as the TeamSTEPPS-endorsed cuss words, were helpful and effective in this setting. Finally, the last theme identified was debriefing. Participants unanimously felt that debriefing was essential and that it builds a stronger team. Here are a few quotes from our exemplary colleagues, but the primary one I want to highlight is the following. To me, it's like a game film. You review it no matter what. Win or lose, you can always, always, always learn something. All of these findings support a paradigm shift where the responsibility is no longer solely of the procedural list, but of the entire team to improve outcomes and the delivery of high-quality care. And the way to do so is to focus on the following four domains through a novel concept of team supervision. In conclusion, video-reflexive ethnography identified solutions to optimize team dynamics and improve safety during emergent endotracheal intubations. Thank you all so much for your time, and I'm happy to take any questions. All right. My name is Jay Siva. I'm a third-year internal medicine resident, and my project during residency was how can we incorporate gamification into our internal medicine critical care curriculum. So like I said, third-year resident. I'm applying for pulmonary critical care this year and I have no disclosures. So this discussion is going to be talking about how we could provide a framework and our example of what we did to incorporate gamification into some of our internal medicine boot camps for critical care. So we're at CHEST. We understand definitely why simulation is important for a lot of reasons. However, what we wanted to see is why is gamification important in medical education and why we should be incorporating it more into how we teach our trainees. And I think there's a lot of benefits from gamification, but primarily you get a lot of the similar benefits to simulation with active learning, group learning, and allows for repetition. But I think most importantly, it's a very fun way to interact with your colleagues and could provide training in more smaller micro skills, and we'll kind of get into that. So our goal was how can gamification be used to supplement some of our traditional learning styles that we had at our institution. We know that traditional lectures are not always the most active and fun to do, so can we create something that's a little more fun that we get more buy-in from our residents. So what we did is we created a custom medical escape room. So I'm not sure if everyone's familiar with the typical escape room where you have a problem that you have to solve within a certain amount of time. We wanted to incorporate that into, can we change it into more of a medical escape room where you have a patient that's slowly deteriorating and they need to be able to solve different cases before progressing. We used pre- and post-test surveys also to compare our impact of our escape room. So like I said, we had a 30-minute escape room that involved a high-fidelity mannequin, but then we had four separate stations that residents had to solve that kind of tested different aspects that we thought were important in critical care, such as ventilator management, some infectious disease, hematology. We had a vasopressor station and a rheumatology station as well, actually. The correct answers would improve the patient's shock state and worsening answers that would continue to deteriorate. So quickly, our patient was a 53-year-old female who's basically presenting. She has a history of lupus, who developed pulmonary fulminance from group A strep and went into septic shock. So she was having worsening septic shock and hypoxia and developed ARDS. And in order for her to be intubated, the residents had to solve four different stations for that. We did provide hints, which would reduce the case time as a total. And we'll go into each station. So our first station was a vasopressor and sedation station that residents had to correctly connect the mechanism of action you can see on the left here for the mechanism of action with the medication. And each one correct would unlock a endotracheal tube to start with. Our next station was an infectious disease station where they had to use antibiograms as well as using the REMUS puzzle to kind of solve that, to identify that the bug was group A strep and strep pyogenes. The next station was a rheumatology station to correctly identify the appropriate antibody. And what we had was four different urinals that we used, like yellow-colored water, and put little magnets in there so they had to correctly identify the appropriate antibodies for that. And then we're able to get a correct key that would unlock IVIG. Our final case station that they had to solve was a hematology station where they kind of went through some traditional board-style questions. We also incorporated a tag into that as well that they had to solve a problem. And each answer would be correlated with the puzzle on the right, which then you use on the puzzle on the left, which would unlock DIC. So finally, once each station was done and they assembled all their equipment, they had to intubate our patient. And then post-intubation, we had a few ARDS ventilator management questions for them to do as well. So to get into our data, our sample size was approximately 33 internal medicine residents and two respiratory therapy students. We used pre- and post-test surveys to assess how residents improved, as well as the Likert scale as well. Generally, residents reported pretty significant improvements in leading a team in this, but also in their medical knowledge that we wanted to test as well. So we had lupus identification as one of our questions, we had some vasopressor mechanism of action questions, and some imaging questions that everyone improved pretty significantly. I think another added benefit that was kind of hard to quantify was the improved camaraderie we had between residents. This was beginning of the year, and everyone kind of working together in a fun simulation, I think, helped everyone get to know their colleagues a little more as well. We had a few other questions as well that we asked as, like I stated, this helped improve my teamwork skills. We had a question that was how the session helped improve learning from peers, as well as making critical decisions under time. You can see in the green, these are strongly agree and agree. And we had pretty good data on this, as well as most trainees would recommend this going forward, which I thought was very, very powerful as well. So in conclusion, gamification, I believe, is a really strong tool, and we should be incorporating this more in medical education. We have a lot of benefits that we know from simulation, but also creating these immersive experiences to help train specific stations, I think, helped residents a lot. And going forward, this is something we do want to continue. We have a kind of a tamed down version of this for our medical students, but we're eventually hoping that we could kind of expand it for a fellows-level course as well. And that's some of our further investigations, is our hope is eventually we could make a difficult airway escape room similar to this, as well, with different stations that fellows have to solve and kind of work through in a medical escape fashion. Those are my references, and any questions? Yeah. Thank you. Good afternoon, everyone, and thank you for participating in this session. My name is Elizabeth Ziff, and I'm currently a cardiology fellow at Lenox Hill Hospital in New York City. I recently completed my internal medicine residency training at Mount Sinai Morningside and West, and that's where this project took place. And I have nothing to disclose. So today I'm gonna talk to you about a novel simulation-based educational training program to improve internal medicine resident management of post-cardiac surgery patients after cardiac arrest. So for a little background, cardiac arrest following adult cardiac surgery has a very low incidence, and the survival rate is remarkably high, around 79%. This impressive survival rate has been attributed to a high incidence of reversible causes of cardiac arrest in this population. And the Society of Thoracic Surgery has published a protocol to address these reversible causes, which deviates from the typical ACLS. And although this protocol has become the standard of care in managing these patients, it's typically not included in internal medicine residency training. So at Mount Sinai Morningside and West, Mount Sinai Morningside in particular, we have cardiac surgery patients, and internal medicine residents are usually the first responders to come to in-hospital cardiac arrest. And as a third-year medical resident, you're responsible to run cardiac arrest codes overnight. And one particular case was a patient who was post-op day eight after cardiac surgery, who had a cardiac arrest. And although I was not at the code, I thought if I was there, I would have felt very uncomfortable managing that patient because I hadn't been formally trained. And I was actually unaware of the STS protocol. I asked some of my other residents, and they also felt uncomfortable managing that patient. So the goal of this project was to evaluate and improve resident knowledge, comfort, and skill in managing post-cardiac surgery patients after cardiac arrest. So we developed a simulation case based on the STS protocol and developed pre- and post-simulation surveys. We integrated the session into resident ACLS simulation sessions from July to September 2022. And then we used chi-squared analysis and sample T-test, Mann-Whitney U-test to look at the results. So when we surveyed residents, we surveyed 75 residents who partook in this study. And 88% of them said that they had never been trained in post-cardiac surgery patient resuscitation after cardiac arrest. And only 16% had resuscitated a post-cardiac surgery patient. Only 29% of residents identified that there was a difference in resuscitating this population. After the simulation training, 100% of residents were able to identify that there was something different in resuscitating this population. When we asked residents how comfortable they felt resuscitating this population, only 4% said they felt comfortable. And after the simulation training, 67% said they felt comfortable, which was a statistically significant improvement. We also had a knowledge assessment, a five-question quiz based on the STS protocol. And following the simulation session, we saw a statistically significant improvement in scores. So Mount Sinai Morningside and West has one of the largest internal medicine residencies in the country. And by utilizing this simulation session, we were able to provide internal medicine residents with the skills and knowledge they need to feel comfortable resuscitating post-cardiac surgery patients. And it's important to note that this training was only provided to PGY-2 and PGY-3 residents because they're often the co-leaders. However, interns are often the first to arrive at a cardiac arrest as well. So future work could include providing this training for interns after they have received sufficient training in the typical ACLS. So that's my presentation. Thank you, and thanks to the CANS team at Mount Sinai Morningside for providing me the ability to do this project. Thank you.

simulation-based training

educational program

internal medicine residents

post-cardiac surgery patients

cardiac arrest

resuscitation

knowledge assessment