A novel simulation paradigm for medical ICU cardiopulmonary arrest training: the in situ mirror simulation

Simulation training aims to increase exposure to high-stakes low-frequency events like cardiac arrest. However, within our laboratory-based simulation program, we have observed limited buy-in from internal medicine (IM) residents due to competing patient care obligations and a limited fidelity environment. Mirroring patient data within in situ simulation may provide relevance to ongoing resident patient care obligations, increasing buy-in and confidence in management. Clinical data from presently admitted patients in our institution’s medical intensive care unit (MICU) was ‘mirrored’ to create cardiac arrest simulations. Simulations took place in a vacant MICU patient room with resuscitation equipment, including a code cart, saline-substituted medications, and a mannequin capable of endotracheal intubation. The trainee team consisted of one post-graduate year (PGY) 3 IM resident, two PGY-1 residents, and a critical care fellow. A pre- and post-survey was administered to the PGY-3 IM resident to assess confidence in performing technical and non-technical skills. An advanced cardiac life support (ACLS) instructor evaluated PGY-3 IM resident performance using a skills checklist. Eighty-three percent of PGY 3 residents endorsed changes to their practice following the simulation. Confidence increased in skills related to flexible decision-making skills but not for fixed skills such as following ACLS protocol. Qualitative feedback highlighted realism, spontaneity, and debriefing sessions as the most valuable aspects of the program. In situ mirror simulation may be a useful adjunct for IM residency programs suffering similar concerns with learner motivation during laboratory simulation.