Gamification of a Low-Fidelity Paper Doll to Teach Primary Survey to Pediatric Residents

Abstract

When critically ill pediatric patients arrive in the emergency department (ED), a rapid physical evaluation is performed in order to systematically evaluate and address life-threatening conditions. This is commonly referred to as the primary survey. At our institution, pediatric residents are frequently tasked with this role, but they have limited training for or experience with this task. Quality improvement review of real resuscitation recordings at our institution revealed delays in initiation and incomplete primary surveys. We sought to utilize gamification to standardize and optimize reproducible training for the primary survey task for pediatric residents using a low-fidelity paper doll model simulation to improve primary survey performance in actual resuscitations.

Gamified learning for resuscitation education: A systematic review

“…During full-text review, 42 articles were subsequently excluded, leaving 16 articles comprising the final review; 7 randomized trials (RCTs) and 9 observational studies (6 before and after studies, 3 survey-based studies). 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 Table 1 contains the characteristics of these included studies. The PRISMA diagram for the reviewis shown in Fig.…”

“… Self-motivated CPR refresher training over 6 mos. Leaderboard CPR performance change significant in IG ( p < 0.001) Otero-Agra, 2019 14 RCT High school students, Spain 489 (IG 151; CGs groups 338) S (CPR parameters) EVA (training with grade); VFC (non-compulsory w visual feedback); TC (control) GAM: team based competition Competition btw groups of 4 students with scores displayed QCPR score: GAM 90 + 8; EVA 85 + 20 ( p = 0.03); VFC 82 + 21 ( p < 0.001); TC 64 + 28( p < 0.001) Pelletier, 2023 18 Observational Residents, USA 32 A (survey on effectiveness) NA 'Escape room' with sequential tasks to complete Escape room format (working in groups, solving ‘puzzles’) 18/32 respondents rated 'excellent'; 100% of responses said content was applicable Phungoen, 2020 15 RCT 5th yr med students; Thailand 105 (IG 53; CG 52) K (2 MCQ tests, one on ALS algorithm, one on general ALS knowledge); S (ALS scenario score); A (confidence post course) 2 day ALS course Use of game before and during 2 day ALS course Resus Days: smartphone app with video and point based resusc scenarios ALS algorithm test: IG 17 + 2 vs CG 16 + 2 (p = 0.01); ALS knowledge IG 22 + 2 vs CG 22 + 3 ( p = 0.45); Skill test passing score IG 79% vs CG 66% ( p = 0.09); Confidence IG 8 + 1 vs CG 8 + 2 ( p = 0.51) Semeraro, 2017 16 Observational (before and after) High school students, Italy 65 S (CPR parameters) immediately post course and at 3 months NA Use of game interface during CPR “tournament” Relive: screen based interface with video feedback Immediate post course: CC depth 45 + 8 mm vs baseline 31 + 12 mm ( p < 0.01); CC rate 111 + 10 vs baseline 94 + 32 ( p < 0.01); 3 month retention: depth 46 + 15, rate 131 + 37 (vs baseline p < 0.01, vs course NS) Thomas, 2023 19 Observational Residents, USA 16 S (proportion of primary surveys performed by residents) NA Training with 'paper doll' model for primary survey Incentives for vol...…”

“… 8 , 9 Two studies used gamification elements (tournament format or prizes awarded) to incentivize participation in simulation training. 19 , 20 One study used an ‘escape room’ format for emergency medicine resident training. 18 Only one study used actual patient care (primary survey patient assessments during actual resuscitations) as an indirect outcome 19 ; none of the remaining studies examined clinical outcomes.…”

“… 19 , 20 One study used an ‘escape room’ format for emergency medicine resident training. 18 Only one study used actual patient care (primary survey patient assessments during actual resuscitations) as an indirect outcome 19 ; none of the remaining studies examined clinical outcomes. No studies included data regarding cost or resource utilization.…”

“…Healthcare providers were the learners in 14 studies 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 18 , 19 , 20 ; 2 studies examined laypeople (high school students) as learners. 16 , 17 Five studies examined performance between groups or teams 9 , 10 , 17 , 18 , 20 ; and the remaining 12 studies examined individual performance.…”