Improved simulated ventilation with a novel tidal volume and peak inspiratory pressure controlling bag valve mask: A pilot study.

Introduction: The dangers of hyperventilation during resuscitation are well known. Traditional bag valve mask (BVM) devices rely on end users to control tidal volume (Vt), rate, and peak inspiratory pressures (PIP) of ventilation. The Butterfly BVM (BBVM) is a novel device intending to give greater control over these parameters. The objective of this pilot study was to compare the BBVM against a traditional device in simulated resuscitations. Methods: Senior emergency medicine residents and fellows participated in a three-phase simulation study. First, participants used the Ambu Spur II BVM in adult and pediatric resuscitations. Vt, PIP, and rate were recorded. Second, participants repeated the resuscitations after a brief introduction to the BBVM. Third, participants were given a longer introduction to the BBVM and were tested on their ability to adjust its various settings. Results: Nineteen participants were included in the adult arm of the study, and 16 in the pediatric arm. The BBVM restricted Vt delivered to a range of 4-8 ml/kg vs 9 ml/kg and 13 ml/kg (Ambu adult and Ambu pediatric respectively). The BBVM never exceeded target minute ventilations while the Ambu BVMs exceeded target minute ventilation in 2 of 4 tests. The BBVM failed to reliably reach higher PIP targets in one test, while the pediatric Ambu device had 76 failures of excessive PIP compared to 2 failures by the BBVM. Conclusion: The BBVM exceeded the Ambu Spur II in delivering appropriate Vts and in keeping PIPs below target maximums to simulated adult and pediatric patients in this pilot study.

Association of Medical Students' Stress and Coping Skills With Simulation Performance.

INTRODUCTION: Medical students are vulnerable to experience stress, as they are routinely confronted with stressors. Acute stress can reduce students' performance on examinations, and chronic stress can contribute to cognitive disorders. Conversely, stress coping skills can reduce trainees' anxiety. Thus, stress coping skills may help students manage stress effectively and better maintain clinical performance. The goal of this study was to assess the relationship between medical students' stress, workload, stress coping skills, performance-enhancing mental skills, and clinical performance during a simulated clinical scenario. METHODS: During their surgery clerkship rotation, third-year medical students participated in a simulated scenario designed to assess their ability to care for an acutely ill surgical patient. Participants' physiological stress was assessed using heart rate (HR) monitors during the simulation, their perceived stress using the State-Trait Anxiety Inventory, and workload using the NASA-Task Load Index immediately after. Clinical performance was assessed using a global rating scale. Stress coping skills were also assessed. The relationship between performance, stress level, workload, and coping skills was examined. RESULTS: Forty-one third-year medical students voluntarily participated in the study. Participants' clinical performance was negatively correlated with perceived stress and workload during the scenario (P < 0.05). A stepwise linear regression model revealed that higher HR was the main predictor of poorer clinical performance (P < 0.05). CONCLUSIONS: In this study, medical students' HR was associated with poorer performance during a simulated clinical scenario. Adaptive stress coping skills may allow medical students to manage stressful situations and better maintain performance.

Objective Measures of Communication Behavior Predict Clinical Performance.

OBJECTIVE: Effective teamwork and communication are critical to patient outcomes, and subjective assessment tools have been studied in predicting team performances. However, inherent biases remain while using subjective assessment tools. This study hypothesizes that objective communication features can assess and predict clinical performance. DESIGN: Forty 3rd-year medical students participated in the Acute Care Trauma Simulation as the role of doctor, teaming up with a nurse confederate and a simulated patient. Participants conducted postoperative patient management, patient care diagnoses, and treatment. Audio from all team members were recorded, speech variables (e.g., speech duration, number of conversations, etc.) were extracted, and statistical analyses were performed to associate communication with clinical performance. SETTING: This study was performed at the simulation center located at Fairbanks Hall, Indiana University School of Medicine. PARTICIPANTS: Data from forty 3rd-year medical students were collected and analyzed. RESULTS: Majority (67%) of the communications were initiated by student. Speech ratio, intensity, and frequency of communications differed when students communicate with nurse than with patient (e.g., student communication to patient had higher intensity than nurse). Increasing frequency of check-backs between student and nurse (p < 0.05) and speech duration from student to patient (p = 0.001) positively associated with student's clinical performance score. CONCLUSION: Objective communication features can predict medical trainee's clinical performance and provide an objective approach for simulation-based trauma care training.