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Simul Healthc. 2018 Oct 31. doi: 10.1097/SIH.0000000000000343. [Epub ahead of print]

Preparing the Next Generation of Code Blue Leaders Through Simulation: What's Missing?

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From the Department of Medicine, London Health Sciences Centre (AKS, KS, DM, SB), Western University, Schulich School of Medicine & Dentistry, London, ON; Division of Cardiology (SB), Jewish General Hospital, McGill University, Montreal, QC; and Department of Health and Rehabilitation Sciences (AR), University of Western Ontario, London, ON, Canada.



Despite the increasing reliance on simulation to train residents as code blue leaders, the perceived role and effectiveness of code blue simulations from the learners' perspective have not been explored. A code blue Simulation Program (CBSP), developed based on evidence-based simulation principles, was implemented at our institution. We explored the role of simulation in code blue training and the differences between real and simulated code blues from the learner perspective.


Using a thematic analysis approach and a purposeful sampling strategy, residents who participated in the CBSP were invited to participate in one of the three focus groups. Data were collected through small group discussions guided by semistructured interviews. The interviews were audio-recorded and transcribed. Interview transcripts were coded to assess underlying themes.


Thematic analysis revealed that participants believed that the CBSP enhanced preparedness by capturing aspects of real codes (eg, inclusion of precode scenarios with awake patients, lack of readily available information) and facilitating automatization of code blue processes. Despite efforts to develop a high-fidelity simulation, participants noted that they experienced more anxiety, observed more chaos in the environment, and encountered different communication challenges in real codes.


The CBSP enhanced resident preparedness to serve as code blue leaders. Learners highlighted that they valued the CBSP; however, differences remain between simulated and real codes that could be addressed to enhance the fidelity of future simulations.

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