Early Recognition of and Response to Acute Deterioration (ERRAD): Teaching Critical Care Thinking to Medical Students
CCCF ePoster library. Filewod N. Nov 1, 2016; 150961; 80 Disclosure(s): No relevant relationships
Dr. Niall Filewod
Dr. Niall Filewod
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#80

Topic: Education

Early Recognition of and Response to Acute Deterioration (ERRAD): Teaching Critical Care Thinking to Medical Students


M. Labelle MDCM FRCPC1, NCJ Filewod MSc MDCM FRCPC2, NZ Sun MDCM MHPE FRCPC3 J Wiseman MDCM MAEd FRCPC FACP3
1 : Division of General Internal Medicine, McGill University
2 : Interdepartmental Division of Critical Care Medicine, University of Toronto
3: Assistant Professor, Centre for Medical Education and Division of General Internal Medicine, McGill University
 



Abstract:

Introduction:
Canadian medical students receive little or no formal training in the approach to deteriorating ward patients. A survey of graduating McGill medical students found that <2% felt confident that they could stabilize a deteriorating patient before help arrived. As first-year residents on call are typically the first to be notified of a deteriorating patient, this presents a significant safety issue.

Objectives:
The ERRAD course aims to prepare final-year medical students to respond to deteriorating medical patients using an algorithmic approach, to teach them appropriate initial management of common medical emergencies, and to train them to deliver adequate handover.

Methods:
The course consists of two half-day sessions. Small groups of students participate in 'Deteriorating Patient' simulation sessions under the guidance of a tutor trained in the use of this simple and rapid teaching method. The simulations recreate common emergencies on the medical ward, with high functional alignment with basic stabilisation tasks. They progress in complexity.  During the sessions, the 'patient' progressively deteriorates while the tutor adjusts the scenario to optimize the cognitive load of the learner attempting the scenario. Each simulation is followed by a debrief.

After a successful pilot, the ERRAD course was expanded to enrol 58 final-year medical students at McGill in spring 2016. Surveys and multiple-choice tests were administered to students to assess changes in their perception of readiness to initiate management of a deteriorating patient while waiting for help to arrive, and to assess their knowledge of how to think through basic ward emergencies.

Data analysis was performed using R.

Results:
Prior to the workshop, students felt unprepared to manage an acutely deteriorating patient on the first day of residency, and did not feel confident that they could stabilize a deteriorating patient while waiting for help.  Following the workshop, students reported improved readiness to manage an acutely deteriorating patient, more confidence in their ability to stabilize a patient while waiting for help to arrive, and improved communication ability (Figure 1; p<0.05 for these Likert scale items). Average score on the knowledge assessment test improved from 9.5 ± 1.7 pre-workshop to 11.5 ± 1.5 post-workshop (max. score 15; T-test p<0.05).

Conclusion:  
The ERRAD course is a simple and effective means of preparing final-year medical students to appropriately think through the most important basic steps to take in response to acutely deteriorating patients. Ongoing work includes the further integration of ERRAD into the McGill medical curriculum, as well as the development of related digital learning tools.


 


References:

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