Improving medical students’ responses to emergencies with a simulated cross-cover paging curriculum

Abstract

New residents are often unprepared to respond to medical emergencies. To address this gap, we implemented a simulated cross-cover paging curriculum. All senior medical students enrolled in a required specialty-specific (internal medicine, procedures, emergency medicine [EM], obstetrics and gynecology [OBGYN], family medicine and pediatrics) residency preparation course (RPC) in 2020–2021 participated. Students received 3–6 specialty-specific pages that represented an urgent change in clinical status about a simulated patient. For each page, students first called a standardized registered nurse (SRN) to ask additional questions, then recommended next steps in evaluation and management. The SRNs delivered immediate verbal feedback, delayed written feedback, and graded clinical performance using a weighted rubric. Some items were categorized as ‘must do,’ which represented the most clinically important actions. Trends in clinical performance over time were analyzed using the Jonckheere–Terpstra test. Of the 315 eligible students, 265 (84.1%) consented for their data to be included in the analysis. Clinical performance improved from a median (interquartile range) of 59.4% (46.9%, 75.0%) on case 1 to 80.0% (68.0%, 86.7%) on case 6 (p < .001). The percentage of ‘must do’ items improved significantly, from 69.2% (53.8, 81.8%) to 80.0% (66.7%, 88,9%) (p < .001). Scores improved over time for all specialty courses except for EM and OB/GYN. Surveyed students largely found this to be a valuable addition to the RPC curriculum with a 4.4 overall rating (1 = poor to 5 = excellent). This novel curriculum fills important gaps in the educational transition between medical school and residency. The simulated paging platform is adaptable and generalizable to learners entering different residency specialties.