Preparing primary care offices to manage common medical emergencies requires routine training of staff. The American Academy of Pediatrics recommends simulated exercises, or mock codes, for staff to practice the steps of an emergency. Our large urban pediatric primary care office sees >300 patients daily and provides care to the largest number of medically complex patients in our network of 31 practices. With our large patient volumes and high acuity, our office averages 2 patients per week that require emergent stabilization or additional evaluation in an emergency room. We typically hold in-person mock codes semiannually. However, during the COVID-19 pandemic, approximately half our staff was in the office each day, and the other half had alternative work arrangements. By late March 2020, we realized we needed to revamp our mock code plan to educate staff about medical emergencies while practicing social distancing.
Approach
In April 2020, we launched virtual interprofessional small group mock codes. Using a video conferencing platform, we brought together ∼5 staff and 1 facilitator. Roles included: medical assistants, registered nurses, physicians, nurse practitioners, and phlebotomists. Materials were emailed to staff to review prior to the session. The facilitator hosted the online meeting from the office. During each 35-minute session, the team collaborated via video conference to manage a common pediatric emergency: a seizure. The staff virtually “assessed” the child, reviewed emergency protocols, and assigned team roles. The facilitator coached the group to describe locations of supplies in the code cart and office. When directed by team members, the facilitator demonstrated how to use appropriate equipment and treatments. Each session concluded with a short debrief to reflect on strengths as well as learning gaps.
Outcomes to Date
In 2 weeks, 90% of our clinical staff (72 people) participated in 1 of 13 virtual mock codes. Fifty-four percent of participants completed a postsession survey. Total 96.4% of respondents agreed the session met the learning objectives; 97.3% liked the virtual learning opportunity during a pandemic; 97.3% named 2 key points retained during the session. Positive comments included: appreciated reviewing office emergency supplies; enjoyed the creative interactive education option from home; easier to learn in small groups. Feedback included: prefer a longer session; prefer hands-on learning; add a video clip of the “patient”; identify a video conference platform with fewer technological issues.
Next Steps/Planned Curricular Adaptations
The reinvention of our mock code to a virtual format was feasible to implement on short notice and successfully met the intended learning objectives. The critical thinking and clear communication that is both necessary and challenging in a medical emergency was demonstrated during these small group video conference sessions. Our outcomes met Level 2 of Kirkpatrick's framework. Lessons learned from this experience can easily be applied to future mock code trainings—both now, while social distancing is necessary, and when COVID-19 is a distant memory. In particular, it is clear that smaller group trainings improve participation by all team members. Therefore, after COVID-19, we will adapt our mock codes by using small group online sessions to supplement our annual in-person trainings. We also plan to strengthen these virtual learning experiences by incorporating tools that augment simulated reality, such as pairing the case with a “patient” video or using a simulation manikin.