P0738 - Gastrointestinal Bleeding Simulation Improves Resident Knowledge and Confidence

Marni H. Wilkoff, DO¹, Emily Seltzer, DO², Nicholas R. Piniella, DO, MS³, Harrindra Seepersaud, PhD, MPH, MA, MS², Priscilla Loanzon, RN², Susannah Kurtz, MD², James Salonia, MD², Daniela Jodorkovsky, MD^4
1Mount Sinai Morningside/West, New York, NY; ²Mount Sinai West, New York, NY; ³New York Institute of Technology College of Osteopathic Medicine, New Jersey, NJ; ⁴Mount Sinai Center for Gastrointestinal Physiology & Motility, New York, NY

Introduction: Upper gastrointestinal (GI) bleeding from peptic ulcer disease (PUD), esophageal varices (EV), or erosive esophagitis, account for approximately 350,000 admissions annually. Simulation-based training is a popular medical education tool, with enhancement of quality care and patient safety, and can help learners recognize a disease process, initiate proper workup, and treatment. To increase internal medicine (IM) resident exposure to critical aspects of GI, a GI bleed simulation curriculum was created.

Methods: One hundred and twenty-nine IM residents, split into 16 groups, participated in a 1-hour hands-on high-fidelity manikin simulation. Pre- and post-simulation REDCap surveys were distributed and included demographic, confidence scale, and knowledge assessment questions. A case outline included a narrative description, learning objectives, critical actions, history of present illness, vital signs, and physical exam. Participants encountered a patient with a past medical history of alcohol use disorder presenting to the emergency department with abdominal pain and swelling. A rapid response was called 12hrs after admission for hematemesis and hemodynamic instability. Progression of the case was detailed with changing vital signs, exam findings and labs. Key equipment included a high-fidelity manikin, code cart, introducer kit, and moulage hematemesis and melena. A post-simulation debrief focused on inpatient and outpatient management of EV and PUD, central venous access, massive transfusion protocol, and hemorrhagic shock.

Results: There was a significant increase in the level of confidence for interns (PGY1) and second year (PGY2) residents in all categories (p < .05). Third year (PGY3) residents had a significant increase in confidence in managing acute variceal bleeds (p = 0.03), peptic ulcer bleeding (p = 0.002), and outpatient EV (p = 0.003).

There was a significant increase in PGY1 and PGY2 knowledge on treatment of non-variceal GI bleeds (p = < .001, p = 0.001). All residents had a significant increase in their knowledge of timing of endoscopy for acute EV bleeds (p < .001). Among all residents combined, there was a statistically significant increase in knowledge of discharge medications for EV and PUD (p = 0.01).

Discussion: Simulation is a prevalent tool used in medical education. This study showed that implementation of a hands-on manikin simulation has a positive impact on IM resident comfort and knowledge managing GI bleeds.


Disclosures:


Marni H. Wilkoff, DO¹, Emily Seltzer, DO², Nicholas R. Piniella, DO, MS³, Harrindra Seepersaud, PhD, MPH, MA, MS², Priscilla Loanzon, RN², Susannah Kurtz, MD², James Salonia, MD², Daniela Jodorkovsky, MD⁴. P0738 - Gastrointestinal Bleeding Simulation Improves Resident Knowledge and Confidence, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.