Background Over 6000 children have an in‐hospital cardiac arrest in the United States annually. Most will not survive to discharge, with significant variability in survival across hospitals suggesting improvement in resuscitation performance can save lives. Methods and Results A prospective observational study of quality of chest compressions ( CC ) during pediatric in‐hospital cardiac arrest associated with development and implementation of a resuscitation quality bundle. Objectives were to: 1) implement a debriefing program, 2) identify impediments to delivering high quality CC , 3) develop a resuscitation quality bundle, and 4) measure the impact of the resuscitation quality bundle on compliance with American Heart Association ( AHA ) Pediatric Advanced Life Support CC guidelines over time. Logistic regression was used to assess the relationship between compliance and year of event, adjusting for age and weight. Over 3 years, 317 consecutive cardiac arrests were debriefed, 38% (119/317) had CC data captured via defibrillator‐based accelerometer pads, data capture increasing over time: (2013:13% [12/92] versus 2014:43% [44/102] versus 2015:51% [63/123], P <0.001). There were 2135 1‐minute cardiopulmonary resuscitation (CPR) epoch data available for analysis, (2013:152 versus 2014:922 versus 2015:1061, P <0.001). Performance mitigating themes were identified and evolved into the resuscitation quality bundle entitled CPR Coaching, Objective‐Data Evaluation, Action‐linked‐phrases, Choreography, Ergonomics, Structured debriefing and Simulation (CODE ACES 2 ). The adjusted marginal probability of a CC epoch meeting the criteria for excellent CPR (compliant for rate, depth, and chest compression fraction) in 2015, after CPR Coaching, Objective‐Data Evaluation, Action‐linked‐phrases, Choreography, Ergonomics, Structured debriefing and Simulation was developed and implemented, was 44.3% (35.3–53.3) versus 19.9%(6.9–32.9) in 2013; (odds ratio 3.2 [95% confidence interval:1.3–8.1], P =0.01). Conclusions CODE ACES 2 was associated with progressively increased compliance with AHA CPR guidelines during in‐hospital cardiac arrest.

Summary Statement Rapid-cycle deliberate practice (RCDP) is a learner-centered simulation instructional strategy that identifies performance gaps and targets feedback to improve individual or team deficiencies. Learners have multiple opportunities to practice observational, deductive, decision-making, psychomotor, and crisis resource management skills. As its implementation grows, simulationists need to have a shared mental model of RCDP to build high-quality RCDP-based initiatives. To compare and make general inferences from RCDP data, each training needs to follow a similar structure. This article seeks to describe the fundamentals of RCDP, including essential components and potential variants. We also summarize the current published evidence regarding RCDP's effectiveness. This article serves to create a shared understanding of RCDP, provide clear definitions and classifications for RCDP research, and provide options for future RCDP investigation.

This brief educational intervention was shown to be effective 4 months after instruction in achieving and retaining competency of defibrillation skills by first-year pediatric residents. In the process, we uncovered educational gaps in cardiopulmonary resuscitation and other resuscitation skills that need to be addressed in future educational interventions and training.

BackgroundThere are currently training gaps, primarily procedural and teamwork skills, for pediatric emergency medicine (PEM) fellows. Simulation-based learning (SBL) has been suggested as an educational modality to help fill those gaps. However, there is little evidence suggesting how to do so. The objective of this project is to develop and implement an SBL curriculum for PEM fellows with established curriculum development processes and instructional design strategies to improve PEM fellowship training.MethodsWe developed a 12-month longitudinal SBL curriculum focused on needs assessment, instructional strategies, and evaluation. The curriculum development process led us to combine the instructional strategies of debriefing with good judgment, rapid cycle deliberate practice, and task-training to improve core PEM skills such as procedural competence, crisis resource management, and managing complex medical and traumatic emergencies. Using multiple approaches, we measured outcomes related to learners (attendance, performance, critical procedure opportunities), instructor performance, and program structure.ResultsEight/Eight (100%) PEM fellows participated in this curriculum from July 2015 to June 2017 with an overall attendance rate of 68%. Learners self-reported high satisfaction (4.4/5, SD = 0.5) and perceived educational value (4.9/5, SD = 0.38) with the curriculum and overall program structure. Learners had numerous opportunities to practice critical procedures such as airway management (20 opportunities), defibrillator use (ten opportunities), and others (ten opportunities). Learner Debriefing Assessment for Simulation in Healthcare (short version) scores had mean scores greater than 5.8/7 (SD = 0.89) across all six elements.ConclusionsThis longitudinal SBL curriculum combining debriefing with good judgment and rapid cycle deliberate practice can be a feasible method of reducing current training gaps (specifically with critical procedure opportunities) in PEM fellowship training. More work is needed to quantify the training gap reduction and to refine the curriculum.

This paper suggests the importance of improving communication during the handover and transport process through establishing standardised patient severity of illness criteria, use of standardised tools and team-to-team handover processes.

Background Virtual Reality (VR) simulation has been found to be useful in learning technical and non-technical skills. However, empirical data about its efficacy in clinical education are limited. This pilot study compares the efficacy of VR to mannequin-based simulation for learners managing status epilepticus (SE). Methods Pediatric and emergency medicine interns at an academic tertiary care referral center were randomized to either VR (intervention, using an Oculus Rift Ⓡ (Occulus from Facebook, Facebook Inc., USA)) or mannequin-based (control) simulation for the same SE scenario. The control group participated in two mannequin-based simulation sessions while the intervention group had a VR session followed by a mannequin-based session. Sessions were one-one with an instructor and held three months apart. Performance was assessed by measuring the time-to-critical actions during the second session. Results Of 42 interns, 22 were in the intervention group and 20 in the control group. There was no statistical difference in time-to-critical actions for VR vs. standard groups; for example, VR times (in seconds) compared to standard times were 18.1 (SD 10.5) and 18.9 (SD 15.8) (p=.90) for oral suction, and 61.6 (SD 24.8) and 62.8 (SD 26.9) (p=.82) for IV lorazepam completion. Conclusion This pilot trial suggests that VR is feasible for clinical simulation. We did not find a significant difference between the two groups in learner performance. Larger studies are needed to corroborate our findings, investigate the best applications of VR in clinical training, and determine if it could lead to more rapid learning at a lower cost.

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