Under the direction of Dr. Kapil Rajwani, a comprehensive simulation program is offered with three primary components: bedside procedures, point-of-care ultrasonography, and code team training. Bedside procedures, including thoracentesis, paracentesis, lumbar punctures and central lines, are the domain of the well-trained internist. These skills are taught using multimedia tools and hands-on workshops with simulation models. Each intern is directly observed performing these procedures to ensure competence before performing them on patients.
Over the course of the intern year, each trainee will become adept at using bedside ultrasonography as an extension of the physical exam. In addition to visualizing the heart, lungs, and other organs, ultrasonography as a bedside procedure aid is the best practice to ensure safe care with these invasive tools. Residents learn to use ultrasound to inform their clinical decisions in various scenarios (e.g., pericardial tamponade or RV collapse from pulmonary embolism, among others). A clinical elective is offered for residents interested in gaining more hands-on experience. Residents can record studies they perform for quality assurance, and to create a personal portfolio of teaching cases.
Code Team Training
Finally, the internal medicine residents serve as the primary leaders and members on the hospital code team. The simulation curriculum consists of training on a high fidelity task trainer to allow interns to practice their clinical decision making, as well as their team leadership and communication skills. In addition, the medical house staff participate in in-situ simulation during monthly mock codes in the hospital, as part of their inter-professional team training and the patient safety curriculum. The mock codes consist of having the code team called to a hospital bed where the high fidelity task trainer is placed in lieu of a real patient, and running through a scenario that may be encountered in an actual rapid response or cardiac arrest. The nurses, pharmacists, respiratory therapists and others on the code team respond as if it were a real code, which is then followed by a short debrief after the exercise. The training helps reinforce closed-loop communication and smooth execution of high-pressure life or death events.