Development of Critical Communication Skills in a Boot Camp Simulation Curriculum for Emergency Medicine Interns Jessica Parsons, MD; Sharon Griswold-Theodorson,

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Development of Critical Communication Skills in a Boot Camp Simulation Curriculum for Emergency Medicine Interns Jessica Parsons, MD; Sharon Griswold-Theodorson, MD, MPH; Michael Pasirstein, MD; John Erbayri, BS, NREMT-P; Jami Smith, PA; Romy Nocer, PhD Drexel University College of Medicine / Hahnemann University Hospital, Department of Emergency Medicine, Philadelphia, PA BACKGROUND METHODS RESEARCH OBJECTIVE Residency programs are increasingly implementing boot camps, intensive preparatory courses to ease the transition from medical school to residency Boot camps have demonstrated increased confidence and procedural competence of new interns Few studies have evaluated a boot camp’s ability to teach non-technical skills (NTS) such as leadership, problem solving, communication, teamwork, situational awareness, and resource utilization The Drexel Emergency Medicine (EM) boot camp curriculum was designed to improve medical knowledge and procedural skills Allows for deliberate and supervised practice of the NTS required of EM physicians Improve non-technical skills of EM interns through an intensive boot camp simulation curriculum Prospective cohort study using sample of 15 interns in June/July, 2015 All interns were given a short didactic presentation of the principles of NTS and divided into three teams to participate in nine simulation scenarios during the boot camp (Table 1) Following each simulation scenario, teams were debriefed on both the medical management and the NTS required during the case. Initial and final simulation scenarios during the boot camp were observed and scored by two independent raters using a previously validated assessment tool, the Ottawa Crisis Resource Management Global Rating Scale (GRS) A paired t-test compared initial and final NTS performances during the boot camp Interns completed a survey to self-assess their improvement in NTS RESULTS Results demonstrated a statistically significant improvement in overall NTS, leadership, problem solving, communication, teamwork, and resource utilization skills (Figure 1) Communication skills had the highest rate of improvement, where the initial average team score of 3.5 increased to 6.5 on the seven point GRS scale (p < 0.001) The inter-rater reliability was Kappa = 0.585, 95% CI (0.4844, ). Self-assessed improvement in NTS also showed that the interns believed all domains of NTS improved, with communication again having the highest degree of improvement (Figure 2) Figure 2: Self-Assessed Improvement in Non-Technical Skills Figure 1: Average GRS Score Improvement CONCLUSION Critical communication and other NTS can be improved over the course of a two-week boot camp through a simulation curriculum Table 1: Boot Camp Scenarios Ectopic Pregnancy* Thoracic Aortic Dissection Severe Asthma with Pneumothorax Septic Shock/Pneumonia Advanced Cardiac Life Support Pediatric Advanced Life Support Opiate Overdose Acute ischemic CVA Abdominal Aortic Aneurysm Rupture* * NTS independently rated by two faculty members

Development of Critical Communication Skills in a Boot Camp Simulation Curriculum for Emergency Medicine Interns Jessica Parsons, MD; Sharon Griswold-Theodorson, MD, MPH; Michael Pasirstein, MD; John Erbayri, BS, NREMT-P; Jami Smith, PA; Romy Nocera, PhD Drexel University College of Medicine / Hahnemann University Hospital, Department of Emergency Medicine, Philadelphia, PA Figure 1: Average GRS Score Improvement

Development of Critical Communication Skills in a Boot Camp Simulation Curriculum for Emergency Medicine Interns Jessica Parsons, MD; Sharon Griswold-Theodorson, MD, MPH; Michael Pasirstein, MD; John Erbayri, BS, NREMT-P; Jami Smith, PA; Romy Nocer, PhD Drexel University College of Medicine / Hahnemann University Hospital, Department of Emergency Medicine, Philadelphia, PA BACKGROUND METHODS RESEARCH OBJECTIVE Residency programs are increasingly implementing boot camps, intensive preparatory courses to ease the transition from medical school to residency Boot camps have demonstrated increased confidence and procedural competence of new interns Few studies have evaluated a boot camp’s ability to teach non-technical skills (NTS) such as leadership, problem solving, communication, teamwork, situational awareness, and resource utilization The Drexel Emergency Medicine (EM) boot camp curriculum was designed to improve medical knowledge and procedural skills Allows for deliberate and supervised practice of the NTS required of EM physicians Improve non-technical skills of EM interns through an intensive boot camp simulation curriculum Prospective cohort study using sample of 15 interns in June/July, 2015 All interns were given a short didactic presentation of the principles of NTS and divided into three teams to participate in nine simulation scenarios during the boot camp (Table 1) Following each simulation scenario, teams were debriefed on both the medical management and the NTS required during the case. Initial and final simulation scenarios during the boot camp were observed and scored by two independent raters using a previously validated assessment tool, the Ottawa Crisis Resource Management Global Rating Scale (GRS) A paired t-test compared initial and final NTS performances during the boot camp Interns completed a survey to self-assess their improvement in NTS RESULTS Results demonstrated a statistically significant improvement in overall NTS, leadership, problem solving, communication, teamwork, and resource utilization skills (Figure 1) Communication skills had the highest rate of improvement, where the initial average team score of 3.5 increased to 6.5 on the seven point GRS scale (p < 0.001) The inter-rater reliability was Kappa = 0.585, 95% CI (0.4844, ). Self-assessed improvement in NTS also showed that the interns believed all domains of NTS improved, with communication again having the highest degree of improvement (Figure 2) Figure 2: Self-Assessed Improvement in Non-Technical Skills Figure 1: Average GRS Score Improvement CONCLUSION Critical communication and other NTS can be improved over the course of a two-week boot camp through a simulation curriculum Table 1: Boot Camp Scenarios Ectopic Pregnancy* Thoracic Aortic Dissection Severe Asthma with Pneumothorax Septic Shock/Pneumonia Advanced Cardiac Life Support Pediatric Advanced Life Support Opiate Overdose Acute ischemic CVA Abdominal Aortic Aneurysm Rupture* * NTS independently rated by two faculty members

Development of Critical Communication Skills in a Boot Camp Simulation Curriculum for Emergency Medicine Interns Jessica Parsons, MD; Sharon Griswold-Theodorson, MD, MPH; Michael Pasirstein, MD; John Erbayri, BS, NREMT-P; Jami Smith, PA; Romy Nocera, PhD Drexel University College of Medicine / Hahnemann University Hospital, Department of Emergency Medicine, Philadelphia, PA Figure 2: Self-Assessed Improvement in Non-Technical Skills

Development of Critical Communication Skills in a Boot Camp Simulation Curriculum for Emergency Medicine Interns Jessica Parsons, MD; Sharon Griswold-Theodorson, MD, MPH; Michael Pasirstein, MD; John Erbayri, BS, NREMT-P; Jami Smith, PA; Romy Nocera, PhD Drexel University College of Medicine / Hahnemann University Hospital, Department of Emergency Medicine, Philadelphia, PA References: Ataya, R., Dasgupta, R., Blanda, R., Moftakhar, Y., Hughes, P. G., & Ahmed, R. (2015). Emergency medicine residency boot cAMP curriculum: a pilot study. West J Emerg Med, 16(2), doi: /westjem Esterl, R. M., Jr., Henzi, D. L., & Cohn, S. M. (2006). Senior medical student "Boot Camp": can result in increased self-confidence before starting surgery internships. Curr Surg, 63(4), doi: /j.cursur Fernandez, R., Vozenilek, J. A., Hegarty, C. B., Motola, I., Reznek, M., Phrampus, P. E., & Kozlowski, S. W. (2008). Developing expert medical teams: toward an evidence-based approach. Acad Emerg Med, 15(11), doi: /j x Kim, J., Neilipovitz, D., Cardinal, P., & Chiu, M. (2009). A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as "CRM simulator study IB"). Simul Healthc, 4(1), doi: /SIH.0b013e Kim, J., Neilipovitz, D., Cardinal, P., Chiu, M., & Clinch, J. (2006). A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Crit Care Med, 34(8), doi: /01.ccm cc Lowry, R. (n.d.). Kappa as a measure of concordance in categorical sorting. Retrieved August 1, 2015, from Nishisaki, A., Hales, R., Biagas, K., Cheifetz, I., Corriveau, C., Garber, N.,... Nadkarni, V. (2009). A multi-institutional high-fidelity simulation "boot camp" orientation and training program for first year pediatric critical care fellows. Pediatr Crit Care Med, 10(2), doi: /PCC.0b013e d29 Okusanya, O. T., Kornfield, Z. N., Reinke, C. E., Morris, J. B., Sarani, B., Williams, N. N., & Kelz, R. R. (2012). The effect and durability of a pregraduation boot cAMP on the confidence of senior medical student entering surgical residencies. J Surg Educ, 69(4), doi: /j.jsurg Parent, R. J., Plerhoples, T. A., Long, E. E., Zimmer, D. M., Teshome, M., Mohr, C. J.,... Dutta, S. (2010). Early, intermediate, and late effects of a surgical skills "boot camp" on an objective structured assessment of technical skills: a randomized controlled study. J Am Coll Surg, 210(6), doi: /j.jamcollsurg