Shock Simulation Day: Medical Decision-Making and Communication Skills for Managing a Hypotensive Adult in a Rapid Response.
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Galli Massimo, Antinori Spinello, Atzeni Fabiola, Meroni Luca, Riva Agostino, Scirè Carlo, Adorni Fulvio, Quartuccio Luca, Sebastiani Marco, Airò Paolo, Bazzichi Laura, Cristini Francesco, Del Bono Valerio, Manfredi Andreina, Viapiana Ombretta, De Rosa Francesco, Favalli Ennio, Petrelli Enzo, Salvarani Carlo, Govoni Marcello, Corcione Silvia, Scrivo Rossana, Sarmati Loredana, Lazzarin Adriano, Grassi Walter, Mastroianni Claudio, Gaeta Giovanni Battista, Ferraccioli Gianfranco, Cutolo Maurizio, De Vita Salvatore, Lapadula Giovanni, Matucci-Cerinic Marco, Armignacco Orlando, Sarzi-Puttini Piercarlo
Аннотация
METHODS: We developed a 90-minute shock day session that provided internal medicine interns with a cognitive framework for the initial diagnosis and management of shock, which they applied to two simulations. The first simulation involved a patient with septic shock, and the second involved a patient with cardiogenic shock. Critical action checklists were used to assess learners and guide structured debriefs after each simulation. Medical decision-making and communication frameworks were presented through a presession video and a chalk talk. The curriculum was evaluated using pre- and postintervention surveys to assess knowledge and confidence.
RESULTS: Forty-eight interns participated in the session in 2022 and 2023. We observed an increase in the percentage of learners correctly answering a knowledge-based question regarding the amount of fluid administered to a patient in septic shock (pre: 33%, post: 62%, p < .01), as well as increases in learner-reported confidence in leading a rapid response (pre: 9%, post: 62%) and in managing undifferentiated shock (pre: 13%, post: 56%), septic shock (pre: 20%, post: 83%), cardiogenic shock (pre: 2%, post: 54%), hemorrhagic shock (pre: 20%, post: 73%), and anaphylactic shock (pre: 22%, post: 54%, all ps < .01).
DISCUSSION: Employing a variety of pedagogical methods, we demonstrated that intern knowledge and confidence regarding the management of a hypotensive patient during a rapid response can be increased through participation in our curriculum.