Training Residents in ACLS/Code Response Using a Computerized Medical Simulator: Improving Resident Comfort and Preparedness

Internal Medicine residents are responsible for leading thecode response team at most teaching hospitals, yet manygraduating interns (PGY1s) may feel unprepared to runcodes. Currently, the only formal training for house staffis the two-day American Heart Association’s AdvancedCardiac Life Support (ACLS) course, generally required atthe beginning of internship, with recertification necessaryevery two years. This course does not address leadershipskills or a resident’s self-reported sense of comfort withleading a code team within a teaching hospital. Priorinvestigations have highlighted the deterioration inknowledge of important ACLS protocols, with knowledgelevels at or near ACLS training levels within 6 months.1,2Schwid and Sivarajan showed that the use of computerizedACLS simulator on CD-ROM improves retention of theguidelines better than textbook review alone.3 Others haveshown that refresher courses can enhance performance ina mock resuscitation setting, with improvementsmaintained, in part, over several months.4 The use of morelife-like simulation training has recently come into favor,through a variety of commercially available medicalsimulators. We designed an ACLS training program withsuch a medical simulator for interns preparing for theirPGY2 year, namely those residents about to assumeresponsibility for leadership of the code team. Prior to thesimulation training sessions, we collected baseline dataregarding interns’ experiences in code situations andcomfort with the anticipated transition to leading the codeteam, as they advance to the PGY2 year of training