Post In-Hospital Cardiac Arrest Simulation to Improve Medical Decision Making and Communication in Internal Medicine Residents.

Introduction: Cardiac arrest is a common cause of morbidity and mortality in hospitalized patients, and is a critical event that hospital-based physicians must be prepared to manage. While cardiac arrest care follows established algorithms, management of patients after return of spontaneous circulation (ROSC) is more dynamic and nuanced. Resident physicians therefore need structured training to provide high-quality post-ROSC care. Methods: We developed a 90-minute simulation session on postarrest care for internal medicine interns. The session included 2 simulation cases: one involving a patient with ventricular tachycardia arrest in the intensive care unit, and another featuring a patient with pulseless electrical activity arrest in an acute care setting. Interns alternated between roles as participants and observers to both practice and analyze communication and clinical skills. Between simulation cases, a brief teaching talk was delivered to review a framework for post-ROSC care. The curriculum was evaluated using pre- and postsession questionnaires to evaluate changes in knowledge and confidence. Results: Thirty-four learners participated in our curriculum over 2 academic years. We observed a statistically significant increase in the percentage of learners who correctly answered knowledge-based questions about target blood pressure (50% to 100%) and oxygen saturation (22% to 74%) in the post-ROSC period. We also saw significant increases in learners' self-reported confidence in communication (28% to 74%) and ability to generate a differential diagnosis for a cardiac arrest (25% to 74%). Discussion: Our simulation session increased intern knowledge and confidence in managing patients in the post-ROSC setting.