Setup and Execution Of the Blindfolded Code Training Exercise

Summary

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking. 

Abstract

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

Introduction

The blindfolded code training exercise was developed to improve closed-loop communication, the utilization of a conceptual framework to organize the management of a resuscitation, and critical thinking skills. Previous scholars reported that communication, role clarity, and teamwork were enhanced by blindfolding physicians during simulated resuscitations¹. Resident physicians, especially in critical care specialties, are frequently placed in high-acuity situations. In order to appropriately manage these high-risk cases, resident physicians require training in both leadership strategies and communication in high-risk environments

Protocol

All methods described here were exempt from review by the Summa Institutional Review Board. 

1. Preparation

1. Prepare the simulation lab prior to beginning the blindfolded code training exercise. 
   1. Prepare all supplies needed for code resuscitation, including an intravenous (IV) start kit, IV fluids, a code cart, a defibrillator with pads, a bag valve mask, a non-rebreather mask, a nasal cannula, a pulse oximeter, and intubating supplies (including a laryngoscope, an endotracheal tube, a stylet, a syringe, an end-tidal carbon dioxide monitor, and a cardiac monitor).
   2. Place the human-....

Results

As noted in Ahmed et al., all residents (100%, 27/27) agreed/strongly agreed that knowledge obtained during the blindfolded code training exercise could be transferred to the clinical setting⁵. In addition, most residents strongly agreed that the blindfolded code training exercise was more challenging (81.5%, 22/27), allowed them to apply critical thinking skills (81.5%, 22/27), and improved use closed-loop communication (88.9%, 24/27) when compared to typical code training exercises (Tabl.......

Discussion

The blindfolded code exercise consists of several critical steps. First, the exercise requires an initial faculty demonstration to decrease the learners’ intimidation and anxiety toward performing a resuscitation blindfolded. It also serves to give learners an example of a successful performance of the blindfolded resuscitation. Facing the code team leader away from the resuscitation team ensures that the leader is unable to visualize the scenario and forces them to give loud, clear orders (Fig.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Bag valve mask
Blindfold
Blood pressure cuff
Cardiac monitor
Chair
Code Cart			ACLS medications
Defibrillator with pads
Emergency department bed
End-tidal carbon dioxde monitor
Human-patient simulator
Intubation Kit			endotracheal tube, laryngoscope, stylet, 10 mL syringe, endotracheal tube holder
IV fluids			1 L normal saline or lactated ringer's
IV start kit			tourniquet, tape, tegaderm, IV catheter
Nasal cannula
Non-rebreather mask
Pulse oximeter
Step stool
Stethoscope