Skilled management of cardiopulmonary resuscitation, or responding to a “code blue,” is widely considered an important training objective during internal medicine residency. Gaining proficiency in managing a code blue typically depends on event-based experiential learning. In this issue of Academic Medicine, Mickelsen and colleagues report their use of schedule-based stochastic simulation estimates matched with observed code blue data to model the number of annual opportunities a first-year resident has to participate in code blue events. Their data offer compelling evidence that trainees in 2008 had much less opportunity (83% less) to participate in code blue events than did their predecessors in 2002. Mickelsen and coinvestigators speculate that this reduction could be attributable to quality improvement initiatives that may have reduced the total number of code blue situations, as well as to duty hours restrictions that reduced the residents' overall availability to participate. The authors of this commentary discuss the general influence of secular trends on educational needs, and they describe possible strategies to compensate for less “in-the-field” exposure by maximizing the “learning yield per event” and using simulation training methods. Finally, the authors consider the question of whether code blue training remains an appropriate goal for general medicine trainees in the face of evolving trends in health care systems.
Dr. Yang is director of inpatient quality, Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, and assistant professor, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Dr. Howell is director of critical care quality, Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, and assistant professor, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Correspondence should be addressed to Dr. Howell, Critical Care Quality, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215; telephone: (617) 632-7687; fax (617) 632-0369; e-mail: email@example.com.
Editor's Note: This is a commentary on Mickelsen SR, McNeil RB, Parikh PP, Persoff J. Reduced resident “code blue” experience in the era of quality improvement: New challenges in physician training. Acad Med. 2011;86:726–730.