Doc Trial: A Targeted Documentation Curriculum for Emergency Medicine Residents

Background: Performing a transvenous pacemaker (TVP) in emergency medicine (EM) is a high-acuity, lowoccurrence (HALO) procedure essential for stabilizing patients with life-threatening bradyarrhythmias.EM residents have limited opportunities to perform this procedure, making simulation-based training crucial.A novel, inexpensive TVP model adapted from existing literature was constructed to help residents to conceptualize, visualize, and practice performing this complex procedure.The study aimed to evaluate the model's effectiveness in improving EM residents' confidence, procedural competence, and perceived realism.Primary Objective: Assess resident confidence and competence performing a TVP.Secondary Objective: Evaluate the realism of the simulator.Methods: The study included 19 EM residents (PGY1-3) from a tertiary care center in New Jersey.A model costing $86 was adapted from existing literature and constructed with a submersible pump, vinyl tubing, and PVC components.Residents completed a pre-simulation confidence survey, received instructional training, practiced on the model, and were evaluated on procedural competence via a standardized 8-task checklist.Results: Post-simulation, residents were graded on their knowledge, rated their confidence, and rated the model's realism via a 20-question quiz.Statistical analysis was conducted using paired one-tailed t-tests (=0.05).Postsimulation, confidence in performing a TVP with assistance increased by 58.16% (p<0.001), and independent confidence rose by 60.26% (p<0.001).Knowledge of TVP indications improved by 39.74% (p<0.001).Confidence in identifying necessary supplies and procedural steps increased by 55.26% and 58.16%, respectively (p<0.001).Overall, education ratings improved from 23.16% pre to 87.63% postsimulation (p<0.001).Simulator realism scored 4.68/5.00and pacer wire realism rated 4.79/5.00.Competency scores averaged 14.75/16.00(PGY1), 15.00/16.00(PGY2), and 14.83/16.00(PGY3). Conclusion:The TVP simulation training significantly improved resident confidence and proficiency.This lowcost model offered sufficient realism to effectively prepare residents for this rare emergency procedure.Limitations include a small sample size, potential Hawthorne bias, and inability to assess electrical and mechanical capture.