Management of Medical Emergencies on Psychiatry Inpatient Floors: A Novel Simulation-Based Curriculum for Psychiatry Residents

Introduction For most psychiatry residents, training in managing the early phases of acute medical emergencies is limited to exposure during medical school and junior off-service rotations. Patients with psychiatric illnesses, however, often have higher rates of medical comorbidities than their age-matched controls. We developed a half-day medical refresher and simulation curriculum to improve the confidence and efficacy with which psychiatry residents can manage medical emergencies on inpatient floors. Methods Based upon a detailed needs assessment conducted with psychiatry residents at various stages of their training, we developed nine clinical scenarios that could be encountered by psychiatry residents managing inpatient units. These included: shortness of breath; sepsis, acute coronary syndrome; cardiac arrest; seizure; overdose; laceration; asphyxiation from hanging; and smoke inhalation. Training sessions included basic skills stations (such as how to obtain vitals or perform bag mask ventilation). Participants completed anonymous surveys prior to the sessions to provide information on their location and level of residency training and their experience with managing medical emergencies. Pre- and post-training surveys assessed participants' confidence levels with various basic procedural skills and general emergency management. Focus groups were performed to obtain qualitative data about participants' experiences and opinions about the simulation scenarios and training session. Results Level of experience varied among participants with respect to exposure to medical emergencies. Most respondents reported a strong desire to have training sessions on these topics. Reported confidence levels increased across multiple domains. Further, residents in general expressed high satisfaction with the scenarios and skills sessions. Residents also identified topics for further medical simulations. Discussion We developed a half-day simulation curriculum focused on essential emergency skills and initial management of a variety of plausible scenarios that could be encountered on a psychiatry inpatient unit. This curriculum could be easily integrated and regularly run as part of any psychiatry residency program. Most importantly, this program may greatly enhance the confidence and efficacy of psychiatry residents faced with managing the initial phase of medical emergencies.