C Earnshaw H Chant G Knepil CD Rodd The medical student at a cardiac arrest – the elephant or mouse in the room? C Earnshaw H Chant G Knepil CD Rodd I’m Charlotte, a clinical Teaching fellow at Gloucestershire Academy and I am going to talk to you about the role of the medical student at a cardiac arrest

Anecdotally; fear ‘getting in the way’ Background Evidence: Lack of confidence Feeling of exclusion Anecdotally; fear ‘getting in the way’ The role of the medical student in resuscitation: No literature Multiple studies discuss the feelings medical students experience surrounding resuscitation which generally demonstrate a lack of confidence and feeling of exclusion from decisions and scenarios but Anecdotally medical students often stand back and fear ‘getting in the way’ No literature exists for the role of the medical student in resuscitation

Situated learning We already know that integrating core knowledge with clinical practice enhances learning Situated learning is that that takes place in the same authentic context as which it is applied, it relies on interaction, participation and collaboration with those in that environment

Aim To determine: Role of the medical student Barriers to getting involved How to increase participation My aim was to determine whether there IS an accepted role for the medical student attending cardiac arrests? Do any barriers exist to medical student getting involved at cardiac arrests? And what can we do as educators to encourage active participation, if deemed appropriate and safe

Methodology Trust ethics Doctors 5th year medical students UoB ethics Documented in note form Semi-structured interviews (n = 8) Focus groups (n = 2) Focus groups (n = 3) Digitally recorded I collected my data using focus groups and semi-structured interviews. My subjects were doctors, including both specialists and trainees and 5th year medical student who were post ILS training Explained why chose these groups – team leaders, team members, students (only if asked) Original interview questions peer-reviewed Undertaken December 2015 – March 2016 Iterative process adopted throughout Digitally recorded, transcribed verbatim I immersed myself in the data and performed inductive thematic analysis Codes were discussed and themes identified Performed separately for students vs doctors vs resus providers Codes discussed with team Within subthemes similarities and differences in statements were identified Transcribed verbatim Thematic analysis Iterative process adopted throughout

Results: Role of the medical student Open airway Chest compressions Chest compressions Arterial blood gases Skills Skills Cannula Roles Roles My first question was to establish whether there is an accepted role for a medical student at a cardiac arrest Doctors responses are on the left and medical students’ on the right Both parties stated there were skills-based roles the student could adopt. They both frequently reported chest compressions as being a useful role for the Actively involved Active observer Observer Not involved Runner Doctors Medical students

Results: Role of the medical student Open airway Chest compressions Chest compressions Arterial blood gases Skills Skills Cannula Roles Roles My first question was to establish whether there is an accepted role for a medical student at a cardiac arrest Doctors responses are on the left and medical students’ on the right Both parties stated there were skills-based roles the student could adopt. They both frequently reported chest compressions as being a useful role for the Actively involved Active observer Observer Not involved Runner Doctors Medical students

Results: Role of the medical student Open airway Chest compressions Chest compressions Arterial blood gases Skills Skills Cannula Roles Roles My first question was to establish whether there is an accepted role for a medical student at a cardiac arrest Doctors responses are on the left and medical students’ on the right Both parties stated there were skills-based roles the student could adopt. They both frequently reported chest compressions as being a useful role for the Actively involved Active observer Observer Not involved Doctors Medical students

Doctors Medical students Results: Barriers Students not involved Barriers exist Medical students Are involved Few barriers exist Doctors do think barriers exist to medical students becoming involved in cardiac arrest Medical students feel they are involved and thus few barriers exist

Results: Doctors - barriers 4 major themes identified: Perceptions Communication Interpersonal Organisational Barriers to medical students becoming involved in cardiac arrest

Themes: Perceptions No-one available to take responsibility Do not understand roles of resuscitation team members Unsure of ALS algorithm No-one available to take responsibility Lack competency Student focussed elsewhere Not part of the ‘team’ Do I always need to have a title?

Themes: Communication Amongst team From students Team leader to delegate Debrief

Themes: Interpersonal Unfamiliarity Students lack confidence Fear Lack of identification Didn’t engage

Themes: Organisational Timing of cardiac arrests Increase in Trust-wide policies of DNAR orders Re-organisation of cardiac care Chaotic, unpredictable environment Whether team roles are assigned or not Completion of training courses Do I always need to have a title?

Results: Students - barriers 2 major themes: Fear Familiarity Dominant feeling is that they ARE involved at cardiac arrest and thus few barriers exist Although they feel involved some themes did emerge that affected how involved they felt they could be

Results: Fear Hierarchy Negatively affecting patient outcome Getting in the way Hierarchy Responsibility for patient care Unsure if they should be getting involved Negatively affecting patient outcome

Identification of team member Results: Familiarity Team member roles Identification of team member Algorithm ALS Equipment Ward layout

“don’t know what everyone else can do let alone what a medical student ” “There as an extra” “Know who is vaguely co-ordinating” “some [students] just want to run away” “I don’t feel I know enough about how it’s supposed to work…or who is in the team” “never seen a student at a cardiac arrest ” “Know who is vaguely co-ordinating” is this enough? Doctors Students

NOT a learning environment Discussion Similarities Contrasts Fear Level of involvement Familiarity Sense of ownership Competency Similarities: between students and doctors include fear, familiarity, competency and knowledge of the team Contrasts: between medical students and doctors perceived barriers for increased involvement at cardiac arrests Do medical students not understand the many roles they could undertake? Or are they not ready to become more involved? Do doctors encourage participation? NOT a learning environment

Situated learning We already know that integrating core knowledge with clinical practice enhances learning Situated learning is that that takes place in the same authentic context as which it is applied, it relies on interaction, participation and collaboration with those in that environment

Future – What can we do?

What the medical student can contribute Bespoke ILS Adapted to the needs of 2nd year medical students: Familiarity with equipment Shockable vs non-shockable heart rhythms Team roles Based on this work I’ve re-designed the way we deliver resuscitation skills to 2nd years entitled… More practical What the medical student can contribute

Received really positive feedback – poster has been produced by 2nd year medical students

Roles: Chest compressions  observer Encourage students to contribute Conclusion Roles: Chest compressions  observer Encourage students to contribute Cardiac arrest is not a learning environment Debrief should be optimised and become the learning environment I would suggest it could be a learning opportunity but it is NOT a learning environment

Questions

References Kumari KM, Amberkar MB, Alur SS, Bhat PM, Bansal S. Clinical Awareness of Do’s and Dont’s of Cardiopulmonary Resuscitation (CPR) Among University Medical Students – A Questionnaire Study. J Clin Diagn Res. 2014 Jul; 8(7): MC08–MC11 Do TD, Ogrinc MD. Assessing third year medical students’ understanding of code status. J Palliat Med. 2011; 14(11):1254-1258 Understanding how basic life support training is utilised by our medical students on clinical rotation. Critical Care Medicine. 2014;42(12):0090-3493