Junior physician skill and behaviour in resuscitation: a simulation study.
BACKGROUND
Physicians are expected to manage their role as teamleader during resuscitation. During inter-hospital transfer the physician has the highest medical credentials on a small team. The aim of this study was to describe physician behaviour as teamleaders in a simulated cardiac arrest during inter-hospital transfer. Our goal was to pinpoint deficits in knowledge and skill integration and make recommendations for improvements in education.


METHODS
An ambulance was the framework for the simulation; the scenario a patient with acute coronary syndrome suffering ventricular fibrillation during transportation. Physicians (graduation age < or =5 years) working in internal medicine departments in Denmark were studied. The ambulance crew was instructed to be passive to clarify the behaviour of the physicians.


RESULTS
72 physicians were studied. Chest compressions were initiated in 71 cases, ventilation and defibrillation in 72. The median times for arrival of the driver in the patient cabin, initiation of ventilation and chest compressions, and first defibrillation were all less than 1min. Medication was administered in 63/72 simulations (88%), after a median time of 210 s. Adrenaline was the preferred initial drug administered (58/63, 92%). Tasks delegated were ventilations, chest compressions, defibrillation, and administration of medication (97%, 92%, 42%, and 10% of cases, respectively).


CONCLUSIONS
Junior physicians performed well with respect to the treatment given and the delegation of tasks. However, variations in the time of initiation it took for each treatment indicated lack of leadership skills. It is imperative that the education of physicians includes training in leadership.
Høyer
Christian Bjerre
CB
Centre for Medical Education, University of Aarhus, Brendstrupgaardsvej 102, DK-8200 Aarhus N, Denmark. cbh@medu.au.dk
Christensen
Erika F
EF
Eika
Berit
B
D000552:Ambulances; D016887:Cardiopulmonary Resuscitation; D002983:Clinical Competence; D032022:Delegation, Professional; D003718:Denmark; D004554:Electric Countershock / Q000706:statistics & numerical data; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008348:Manikins; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004837:Epinephrine