Via Research Recognition Day 2024 VCOM-Carolinas
Educational Reports
Cardiac Arrest Simulation Response Time: A Comparative Study in Preclinical Medical Education Mari Ascano-Ravelo, RN, OMS-II; Danielle Drew, RN, OMS-III; Elias Bouyounes, OMS-II; Tommy Lindsey, DO; Michael Parks, MPA; David Redden, PhD Edward Via College of Osteopathic Medicine- Carolinas Campus, Spartanburg, SC. Abstract Results Conclusions
• Little research has been done surrounding the topic of the reaction times of medical students to emergent health crises. The role of experience in these situations has not yet been explored and may prove to be very valuable in clinical settings. • When comparing the two median decreases between the groups, the Wilcoxon Rank Sum Test does not achieve statistical significance (p = 0.2750); therefore, we cannot reject the statement that the observed median decreases for the 2 groups are equal. • All individuals from both treatment groups showed statistically significant decrease in their response times as shown in Figure 3 and Figure 4. The improvement in reaction times can prove the significance tailored education has in shaping the preparedness of preclinical students in responding effectively in cardiac arrest situations. Increased exposure and knowledge to cardiac arrest scenarios using simulation may reduce the time to perform CPR among medical students in a real-life clinical scenario, promoting the integration of academic and clinical experience. • We acknowledge the small sample size and possibility of cross contamination from unintentional communication between treatment groups as factors impacting these research findings. • One aspect of this research that received limited attention was the impact repetitive simulation had on the quality of CPR, including the rate and depth of compressions. Subsequent investigations can explore a more comprehensive analysis, evaluating both the time it takes to initiate CPR and the proficiency of compression techniques
Current medical school education in the first two didactic years lacks life-threatening clinical experiences. High-fidelity manikin simulations offer a liability-free way to develop life-saving skills (McCoy et al., 2019). Hospitals use simulation-based teaching for repetitive cardiac arrest scenarios to enhance provider knowledge and performance, recognizing time spent not performing cardiopulmonary resuscitation (CPR) adversely affects patient outcomes (Auerbach et al., 2011). While there is ample research on the qualitative effectiveness of simulation-based teaching, limited quantitative studies assess its success in cardiac arrest scenarios among medical students. Langdorf et al. (2014) found fourth-year medical students took almost two minutes to perform CPR. This study aims to compare the duration between identifying a cardiac arrest and initiating CPR among first-year medical students before and after exposure to cardiac arrest scenarios using a high-fidelity manikin. We hypothesize that exposure to a higher frequency of cardiac arrest scenarios will yield a shorter response time in initiating CPR compared to their counterparts who are exposed to a lower frequency. Study Design: Comparative study on a sample size of 29 first-year medical students. Participants provided exposure to cardiac arrest prior to medical education in a demographic pre-survey. Simulations were completed individually, and timed data was video recorded. "Time to chest" was recorded during their first and last simulated scenarios, referring to the seconds between the initiation of cardiac arrest (asystole) to the initiation of hands-on cardiac resuscitation (CPR). Intervention Details: After the initial cardiac arrest scenarios, 2 balanced treatment groups were created with stratified randomization based on prior cardiac arrest experience. All participants received a PowerPoint presentation on basic electrocardiograms (EKGs). All participants received 6 practice scenarios after the initial simulation as noted in Figure 2, with one group receiving more cardiac arrest scenarios than the other, before their final scenario. Outcomes: The study will show improved response time in students exposed to a higher frequency of cardiac arrest scenarios by exhibiting shorter duration of "time to chest" compared to their counterparts in the lower frequency exposure group. Statistical Approach: All analyses were conducted using SAS 9.4 and all tests utilized a two-tailed Type I error rate of 0.05. • Subjects were randomly assigned to treatment arms using a permuted block design. • Fisher’s Exact Test was used to examine whether randomization had equally distributed baseline characteristics, such as previous experience as a first responder or training. • Histograms and boxplots identified outliers in time to response as observed pre-intervention for both groups as well as outliers in change in time to response for both groups. • Wilcoxon Signed Rank Test was used to evaluate for significant decrease in response times within groups due to these outliers and small sample sizes. • Wilcoxon Rank Sum Test was used to test for differences in the amount of decrease in response times between groups. Methods
Figure 1. Results from demographic pre-survey, indicating number of participants who have had experience, or exposure at minimum, to a cardiac arrest scenario prior to medical school.
Treatment Arms
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Figure 2. The two treatment arms were both exposed to the same number of cardiac rhythms during their practice simulations, however differed from the amount of lethal cardiac rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia.
References
1.Auerbach, M., Kessler, D., & Foltin, J. C. (2011). Repetitive pediatric simulation resuscitation training. Pediatric emergency care, 27(1), 29 – 31. https://doi.org/10.1097/PEC.0b013e3182043f3b 2.Langdorf, M. I., Strom, S. L., Yang, L., Canales, C., Anderson, C. L., Amin, A., & Lotfipour, S. (2014). High-fidelity simulation enhances ACLS training. Teaching and learning in medicine, 26(3), 266 – 273. https://doi.org/10.1080/10401334.2014.910466 3.McCoy, C. E., Rahman, A., Rendon, J. C., Anderson, C. L., Langdorf, M. I., Lotfipour, S., & Chakravarthy, B. (2019). Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality
Figure 3 . The Lethal Treatment Arm had a median decrease in response times from pre to post intervention of 15.5 seconds, minimum decrease of -1.5 seconds, maximum decrease of 274 seconds. The Wilcoxon Signed Rank Test indicated a statistically significant median decrease (p < 0.001) for this group.
Cardiopulmonary Resuscitation. 20 (1), 15 – 22. https://doi.org/10.5811/westjem.2018.11.39040
The authors of this poster would like to thank the VCOM- Carolinas Campus faculty members and Simulation Center staff for their assistance, as well as our participants, without which this study would not have been possible. IRB Reviewal Committee: Edward Via College of Osteopathic Medicine Institutional
Figure 4 . The Normal Treatment Arm had a median decrease in response times from pre to post intervention of 21.25 seconds, minimum decrease of 1.5 seconds, maximum decrease of 306 seconds. The Wilcoxon Signed Rank Test indicates a statistically significant median decrease (p < 0.001) for this group.
Review Board, Blacksburg, VA IRB Protocol Number: 2023-135 IRB approval date: 10/24/2023
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2024 Research Recognition Day
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