Blindfolding Improves Communication in Inexperienced Residents Undergoing ACLS Training

Abstract

Background: Closed-loop communication (CLC) is associated with decreased medical errors and improved time-to-task completion during resuscitations. Depriving team leaders of sight during training may accelerate the acquisition of favorable communication skills; however, its effect on the frequency of CLC is unclear, especially with trainees.

Objective: We assessed the effect of depriving interns of sight during advanced cardiovascular life support (ACLS) on verbal communication patterns and resuscitation confidence.

Methods: All interns undergoing ACLS training in June 2019 at a single center were eligible. Interns were randomized to blindfolded training (BT) or standard training (ST). BT team leaders were blindfolded during practice sessions and permitted to use sight during testing. Testing scenarios were video- and audio-recorded. Recordings were assessed for teams' performance and communication patterns. Participants were surveyed for confidence with resuscitation skills before and after ACLS training.

Results: All 87 eligible interns participated in the study (100% participation). Eighty-five of 87 (98%) interns were included for analysis; 46 were randomized to BT and 39 to ST. Interns in the BT group were significantly more likely to exhibit CLC (mean: BT 20.3, ST 16.6; P = .003), directed communication (mean: BT 4.3, ST 1.5; P < .001), and follower-initiated communication (mean: BT 12.8, ST 10.2; P = .028). There was no significant difference in clinical performance measures or self-reported confidence with resuscitation between BT and ST groups.

Conclusions: Blindfolding trainees results in greater instances of CLC, directed communication, and follower-initiated communication during ACLS training.

Figure

Five Potential Communication Types Abbreviations: L, leader; F, follower. Note: Complete closed-loop communication: team leader directs task; follower verbally acknowledges specific task. Partial closed-loop communication: team leader directs task; follower gives non-specific acknowledgment (“OK”). Open-loop communication: team leader directs task; follower gives no verbal acknowledgment. Directed communication: leader directs specific team member (by name or role) to perform task. Follower-initiated communication: follower initiates communication with leader to provide input regarding patient status or ask prompting question.