December 2007 Press Release
DOCTORS TRAINED ON PATIENT SIMULATORS EXHIBIT SUPERIOR SKILLS
New Research Finds Traditional Training Inadequate
(NORTHBROOK, IL, December 10, 2007)—Senior internal medicine residents who are trained
in critical resuscitation skills on patient simulators become more skilled than residents who undergo
traditional training, according to new research. Though prior studies have already shown that
simulation training is effective in imparting such skills, this study, which appears in the December
issue of the journal Chest, sought to demonstrate the superiority of simulation training over
traditional methods. In doing so, researchers found that simulation-trained residents out-performed
their traditionally trained counterparts in 8 of the 11 steps of initial airway management during a
simulated scenario of respiratory arrest.
"We weren’t surprised by the skills demonstrated in the simulation-trained residents,
although we were quite surprised to see how poorly the traditionally trained residents performed,"
said study author Pierre Kory, MPA, MD, Senior Pulmonary and Critical Care Fellow, Beth Israel
Medical Center in New York. "This finding was quite alarming because traditional training or
‘learning by doing’ is how doctors have historically been trained and continue to be trained, around
the world."
Dr. Kory and his colleagues from Beth Israel Medical Center compared two groups of thirdyear
internal medicine residents; one group received training in initial airway management skills
using a computerized patient simulator during the first year of residency while the other group
received traditional residency training. This "traditional" training, also known as experiential or
apprenticeship training, involves the resident learning on the job, whereas simulated training
involves creating medical scenarios using human-sized mannequins equipped with realistic features,
including pulses, chest wall movements, and audible breath sounds. To assess their skills in initial
airway management, both groups were presented with a simulated scenario of a patient who had
suddenly stopped breathing. Performance scores in the scenario were based on the successful
completion of 11 standard tasks necessary for success in improving blood oxygen level, providing
oxygen, and delivering adequate breaths to a patient who cannot breathe independently.
"In this scenario, the mannequin was programmed to represent a respiratory arrest situation,
but not a cardiac arrest. This means that the ‘patient’ had stopped breathing, but the heart was still
beating," Dr. Kory explained. "The situation required that residents recognize this clinical state and
take certain initial steps of airway management. We then scored each task as completed or not
completed."
Researchers found that 38% of the simulation-trained residents, compared with 0% of the
traditionally trained residents, successfully resuscitated the mannequin. In addition, the simulationtrained
residents performed significantly better in 8 of the 11 tasks of initial airway management.
Researchers also found that only 20% of traditionally trained residents were able to successfully
attach a CPR-bag-valve-mask to oxygen, insert an oral airway device, or achieve an adequate seal
over the mouth with the CPR-bag-valve-mask. According to Dr. Kory, this demonstrates a serious
and pervasive deficiency in critical resuscitation skills.
"It is so important for residency training program directors, and medical educators in
general, to realize just how poor doctors’ resuscitation skills are overall. While the simulationtrained
residents did better, only 38% were successful at resuscitating a simulated patient. These
same residents had shown perfect performance at the end of the training program during their first
year of residency, so there was a significant deterioration in skill level," he said. "What this means
is that more frequent scenario-based training sessions should be provided."
"Patients should have the peace of mind of knowing that their treating physician could save
their life, should they suddenly stop breathing," said Alvin V. Thomas, Jr., MD, FCCP, President of
the ACCP. "Simulation training can provide efficient and effective learning in not only airway
management, but in a number of areas where critical skill is required."
ACCP represents 17,000 members who provide patient care in the areas of pulmonary,
critical care, and sleep medicine in the United States and throughout the world. The ACCP’s
mission is to promote the prevention and treatment of diseases of the chest through leadership,
education, research, and communication. For more information about the ACCP, please visit the
ACCP Web site at www.chestnet.org.
Contact:
Jennifer Stawarz, (847) 498-8306
Deana Busche, (847) 498-8387
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