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A6790 - Assessing and Improving Resident Stress During Rapid Response Scenarios
Author Block: O. Mitchell1, A. Lehr1, M. Lo1, L. M. Kam2, A. Andriotis3, B. Kaufman3, K. J. Felner3, C. Madeira1; 1Internal Medicine, New York University School of Medicine, New York, NY, United States, 2Anesthesiology, New York University School of Medicine, New York, NY, United States, 3Pulmonary Medicine and Critical Care, New York University School of Medicine, New York, NY, United States.
Rationale:
Rapid response teams (RRTs) are extensively used across the United States of America to evaluate and treat deteriorating patients in the hospital and are often led by mid level physicians such as fellows and residents. However, these emergency scenarios are high-stress and time sensitive and leading RRTs in high-stakes scenarios can cause significant stress: impairing recall, impacting teamwork, and leading to errors in patient care.
We sought to quantify the associated levels of stress that residents at our program felt when leading RRTs, as well as to establish their perceptions towards a cognitive aid that we have developed to be used in such scenarios.
Methods:
Internal medicine residents at the New York University School of Medicine were asked to complete a survey regarding their attitudes towards RRTs. They were shown a cognitive aid and given a short didactic session detailing the use of cognitive aids. They were then asked to complete a second survey about their attitudes towards the use of cognitive aids during RRTs.
Results:
27 residents completed both surveys, 81% of which were senior residents (PGY-2 or PGY-3). 44% of residents reported that they felt prepared to lead RRTs. 85% reported feeling stressed or very stressed about evaluating patients during RRTs and 58% reported feeling unsure or very unsure about their decision making during RRTs.
After reviewing the cognitive aid and completing a simulated scenario, 67% felt that cognitive aids helped decision making, 74% felt that cognitive aids relieved stress, and 89% felt that a cognitive aid was helpful or very helpful during the simulation.
Conclusions:
Leading RRTs is a source of considerable stress and uncertainty for internal medicine residents at our institution, with only a minority feeling prepared to lead RRTs and the majority experiencing high levels of stress and uncertainty about evaluating and managing patients during real life RRTs. While evaluating and treating critically unwell patients remains a key aspect of medical training, residency programs should be aware of the high level of stress that comes with such duties.
Residents felt that using a cognitive aid would relieve stress, help decision making, and would be helpful during a simulated RRT. Cognitive aids have long been used in other fields, both medical and non-medical, and have been shown to decrease stress and improve performance. Use of such an aid could be considered in other residency programs to alleviate some of the stress associated with leading RRTs.