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Purpose

Intro to Code Blue (ITCB) provides University of Calgary medical students with experience, knowledge, and confidence in managing cardiac arrest cases (“code blues”), including suggesting initial management plans of acute care cases, early in their training. It aims to enhance the physician competencies of leadership, communication, collaboration, and interdisciplinary teamwork. The session also emphasizes early, effective CPR and early defibrillation.

Learning Objectives

By session conclusion, learners will be able to initiate, facilitate, and participate in cardiac arrest care and general acute care situations. Specifically, learners will:

  • Demonstrate an approach to primary and secondary surveys
  • Suggest initial management plans for select acute care patient presentations (ACS, anaphylaxis, tension pneumothorax, and UGIB)
  • Demonstrate an approach to the management of cardiac arrest cases
  • Discuss the importance of early CPR and defibrillation in cardiac arrest cases
  • Demonstrate effective CPR and BVM techniques
  • Demonstrate accurate dosing and frequency of epinephrine administration in cardiac arrest cases
  • Select the appropriate defibrillation dose for cardiac arrest cases
  • Identify the following code blue rhythms: VF, pulseless VT, PEA, asystole
  • Demonstrate the management of VF, pulseless VT, PEA, and asystole
  • List causes of cardiac arrest, using H’s and T’s as a mnemonic
  • Describe and demonstrate the ACLS elements of effective team dynamics
  • Discuss the roles of the interdisciplinary health care team in cardiac arrest cases

Roll-Out

An initial trial with 4 students and 1 facilitator was held in May 2014. Subsequently, a larger pilot of ITCB was launched at the University of Calgary medical school in June 2014 for second year medical students in their "Intro to Clinical Practice" course. Family Medicine and Internal Medicine residents acted as facilitators. In the June 2014 pilot, 78 learners and 20 facilitators participated. ITCB has become part of the official "Intro to Clinical Practice" curriculum since 2015.


June 2014 Pilot Program

This is the pilot study presented in poster format in 2015 at the "UCalgary Health and Medical Education Scholarship Symposium", "Canadian Association of Emergency Physicians Conference", and "Simulation Summit".

TITLE: Intro to Code Blue (ITCB): combining resident-as-teachers with acute care simulation training for medical students

AUTHORS/INSTITUTIONS: A.V. Seto, Emergency Medicine, University of Calgary, Calgary, Alberta, CANADA

PRESENTATION TYPE: Education

CURRENT CATEGORY: Education Innovations

CURRENT INVESTIGATION TYPE: Survey

ABSTRACT BODY:

Introduction / Innovation Concept: Hands-on practice with CPR and managing code situations is currently absent from the University of Calgary pre-clerkship curriculum. Additionally, there is no formal pre-clerkship curriculum that primarily recruits residents-as-teachers. ITCB’s goals were to (1) increase resident-teaching experience with multiple teaching modalities and (2) establish an effective student educational model for acute care learning.

Methods: Seventy-eight students were divided into groups of maximum four. One facilitator (from nineteen residents and one staff) was assigned to each group. Facilitators delivered a thirty-minute lecture on an approach to code blues and select clinical presentations (acute coronary syndrome, anaphylaxis, tension pneumothorax, and upper gastrointestinal bleeding). Four Simulation OSCEs were run on the same topics, where learners took turns as team leader. Unchecked items on OSCE checklists were the foundation of constructive feedback and discussion. Participants filled pre- and post-program surveys, where they rated their confidence in various domains. Students also completed an examination, comprised of thirty-seven questions (multiple-choice and short-answer), both pre-program and post-program (one hour to forty-three days afterwards).

Curriculum, Tool, or Material: The ITCB resources can be found at http://ucalgary.ca/codeblue. An agenda, information manual, presentation slides, and Simulation OSCE checklists were provided to participants for self-preparation. Additionally, facilitators received presenter notes.

Conclusion: Confidence of learners (N=42) increased in all questioned domains (p<0.001 for all), including team leading/participating, managing acute care presentations, and CPR/BVM skills. Average examination scores (N=42) increased from 63% to 92% (p<0.001). Facilitators (N=6) made gains in confidence across all questioned domains (p<0.05 for all) including conducting lectures, teaching approaches, running simulations, and facilitating debriefs. ITCB, as an educational model, enhances the self-efficacy of resident-as-teachers and simultaneously improves students’ knowledge and self-efficacy in managing acute care situations.

Updates

- February 23, 2017: Sign-ups for facilitators now open. Please see https://ucalgary.ca/codeblue/files/codeblue/itcb-facilitator-invite-2017... for details.

- June 7, 2016: All resources are up-to-date and ready for review now!

- April 6, 2016: This year's ITCB will be Thurs June 23 (13:30, 15:30), Mon June 27 (10:30), and Thurs June 30 (13:30). If you are a resident or staff interested in being a facilitator, please email intro@ucalgary.ca. Stay tuned for more details.

- June 15, 2015: The ITCB materials for the 2015 Intro To Clinical Practice course is up and ready! Please visit the Learner and Facilitator tabs for more information pertinent to your role. Start by reading the "Learner Manual" or "Facilitator Manual". Please fill out your surveys located on the Surveys tab prior to coming to your session.

- April 4, 2015: ITCB has been accepted into UCalgary's "Intro To Clinical Practice" course. The 2015 ITCB workshop will be held on Thursday June 25 @ 1330-1530 and 1530-1730 (Groups “C” and “B” respectively), Monday June 29 @ 1030-1230 (Group “D”), and Thursday July 2 @ 1330-1530 (Group “A”). Please email intro@ucalgary.ca if you are interested in being a facilitator (particularly if you are a resident)!

- November 21, 2014: Preliminary results compiled and shared with UME. Will decide to hold off on piloting another session until next Intro to Clinical Practice in 2015, so that we can evaluate the program and enhance it. Results hopefully to be presented at a symposium soon.

- June 24, 2014: All sign-ups are completely full at this time. Remember to fill out your pre-program surveys under the "Surveys" tab! See you soon!

- June 2, 2014: Found more manikins! Therefore, I can accommodate a few more facilitators now. Feel free to sign up!

- May 21, 2014: Facilitator sign-ups full! All further sign-ups will be placed on wait list.

- May 17, 2014: Four UAlberta medical students pilot ITCB in Calgary. Fun and successful!

- May 16-18, 2014: Facilitator invitations sent out to resident groups.

- May 14, 2014: Learner sign-ups full! All further sign-ups will be placed on wait list.

- May 13, 2014: Official invitation sent to Narwhals (Class of 2016)

- May 11, 2014: Registration for Learners and Facilitators now open!