An Experiential Learning Curriculum to Enhance Emergency Medicine Residents’ Situational Awareness of Patient Safety Hazards
Abstract
Learning Objective: 1. Assess EM residents satisfaction with a patient safety simulation and debriefing 2. Assess EM residents ability to identify hazards and solutions in a simulated patient safety room.
Background: Situational awareness (SA) is essential to patient safety in emergency medicine (EM). SA has 3 ascending levels and is impacted by environment and workload.(Fig.1) Little is known about how EM residents’ SA evolves during training, limiting development of curricula, though simulation may be a promising approach.
Objectives: Our objective was to evaluate EM residents’ SA of hazards in a simulation and assess satisfaction with the exercise and debriefing. We hypothesized senior residents would identify more hazards.
Methods: A cross-sectional observational study was conducted over 3 months with a convenience sample of residents at 2 university-affiliated 3-year EM programs. A simulation scenario was designed, incorporating common safety hazards.(Fig. 2) After reviewing a mock handoff and chart, participants spent 10 minutes in a simulated room documenting hazards and solutions. An interruption and new task were introduced midway to replicate the ED environment and workload. Hazards, solutions, and core SA concepts were discussed during the debriefing. Descriptive statistics were used for hazards and survey responses. A Spearman-Rho coefficient was calculated to assess the correlation between PGY and hazards identified.
Results: 46/91 residents participated in the simulation. Mean hazards identified were 6.12/13(47.1%): Level 1:3.8/6(63.3%), Level 2:1.84/4(46.0%), Level 3:1.13/3(37.7%). There was no correlation between PGY and hazards identified (all hazards: r=0.136,p=0.3655; Level 3: r=-.039,p=0.796). 97.8% and 96.7% reported satisfaction with the exercise and debriefing, respectively. 100% agreed the exercise improved knowledge of ED safety hazards.
Conclusions: Residents identified <50% of hazards; higher level hazards were less frequently identified for all PGYs. This suggests a need for longitudinal SA and patient safety education. Educators should consider incorporating elements of workplace complexity for patient safety education.