CODE BLUE! Does how we feel predict how we do? A quantitative observational study of in-situ, near-peer simulations among internal medicine residents using self-reports and expert ratings

Background: Understanding the impact of residents’ emotions during simulation training may improve preparation for managing Code Blue scenarios. The optimal use of in-situ simulations for deliberate practice of previously learned skills is a growing field. This study applied Pekrun’s Control Value Theory to examine if internal medicine residents’ achievement emotions, driven by appraisals of control and value, influenced their performance following in-situ, near-peer Code Blue simulations facilitated by fellow residents. Methods: This quantitative, cross-sectional observational study involved 74 internal medicine residents (25 leaders, 49 team members) participating in monthly in-situ Code Blue simulations at a Canadian academic hospital. Immediately following each simulation, residents completed self-reports of their emotions and performance. Concurrently, a medical expert used the Ottawa Global Rating Scale to rate code leaders’ performances. Linear regressions were used to assess the predictive relationships between participants’ appraisals of their degree of control over and value for the simulation, their emotions and performance outcomes. Results: Residents primarily reported positive-activating emotions. Among leaders, higher perceived control predicted positive-activating emotions, which in turn predicted better self-reported performance and higher expert ratings. Conclusions: In the context of this voluntary, near-peer, in-situ series of booster simulations aimed at providing learners with deliberate practice of highly valued previously learned skills, learners reported mainly positive activating emotions, which in turn predicted better performance. This study highlights the utility of formative in-situ simulations for enhancing residents’ Code Blue team leadership skills.