Simulation of Inpatient Medical Critical Events for Physicians at a Community Hospital

BACKGROUND: Critical events are common at community hospitals, yet physicians who lead them have had varying levels of training and involvement during their residency and professional development. Little is known about the impact of simulation to improve performance during inpatient critical events among community hospitalist physicians. OBJECTIVES: To determine if hospitalist physicians reported sustained performance improvement regarding critical events as a result of simulation. METHODS: Physicians at a community hospital in Northern California participated in critical event simulation over one year. Self-assessment surveys (scale 1 through 5) were collected before, after, and at 1-month post-simulation. Differences in survey scores and post-simulation trends in total composite survey scores over a 1-month period were compared among participants. RESULTS: From February 2018 through February 2019, 25 of 32 eligible physicians (78%) participated in the simulations. Most were trained in internal medicine (76%), practiced primarily hospital medicine (72%), and had previous experience of at least 5 critical events per year (68%). Participants reported increases in mean survey scores (knowledge +0.8, familiarity +1.0, communication +1.2, technical skills +1.0) which were sustained at one month post-simulation (knowledge +0.8, familiarity +1.0, communication +1.3, technical skills +0.9) (all p < 0.0001). At one month post-simulation, participants who were clinic-based and had <5 years of post-residency experience had higher composite survey score differences compared to those who were hospital-based and had ≥5 years of experience, respectively (p < 0.05). CONCLUSION: Simulation may lead to sustained performance improvement at critical events as reported by community hospitalist physicians. Further investigation is needed.