Repeated Versus Varied Case Selection in Pediatric Resident Simulation

Abstract

Background Repeated exposure to pediatric emergency scenarios improves technical skills, but it is unclear whether repeated exposure to specific cases affects medical decision making in varied cases. Objective We sought to determine whether repeated exposure to 1 scenario would translate to improved performance and decision making in varied scenarios. Methods Senior pediatrics residents participated in 3 scenarios with scripted debriefing. Residents were randomized to repeated practice (RP) scenarios or mixed (MIX) scenarios. RP residents completed pulseless electrical activity (PEA) with different stems (Case 1, 2, 3). MIX residents completed PEA (Case 1), seizure (Case 2), and ventricular tachycardia (Case 3) scenarios. Four months later, participants returned to complete 3 more cases: PEA (Case 4), seizure (Case 5), and critical coarctation (Case 6). Results Twenty-three residents participated in the study and were randomized to either the RP or the MIX group. The RP group showed statistically significant improvement in time to start chest compressions, whereas the MIX group showed no improvement. Use of a backboard improved significantly in Case 4 for the RP group but not for the MIX group. Similarly, time to check glucose in the seizure scenario was significantly better in the MIX group that had previous exposure to a seizure scenario. No differences in performance were noted between groups in Case 6, which was new to both groups. Conclusions Results of this study indicate that whereas repeated exposure may improve decision-making skills in similar scenarios, it may not translate to improved medical decision making in other scenarios.

Effects of Repeated Exposure in Simulation-Based Education on Hospital Emergency Care

“…But most of simulation studies examine only effect right after simulation-based education [5,[25][26][27] and don't ascertain change of performance by repeated exposure in simulation-based education. Consistently with the present study, it is verified that repeated exposure of simulation-based education on hospital emergency care increases performance skill [15,18]. Furthermore, repeated exposure of simulation-based education also increases nontechnical skill, teamwork including attitudes on the superior, job satisfaction, and confidence as a team member [15].…”

“…Many previous studies also present that simulation-based education increases performance skill on emergency care [15,18,27]. But most of simulation studies examine only effect right after simulation-based education [5,[25][26][27] and don't ascertain change of performance by repeated exposure in simulation-based education.…”

“…A study indicates that repeated exposure can improve performance in similar situations but can't improve performance in other situations [18]. Therefore the repeated-simulation educations seems to be an effective method to increase performance skill, but effects of other core nursing competencies and the extension possibility in other clinical situations have to be examined furthermore.…”

“…The more time is needed to operate simulation practice. Recent studies also suggest that repeated exposure in the simulation-based education on hospital emergency care is effective to enhance the performance level [15,18]. At this point, it is needed to compare between the effects of repeated exposure and role experience as a leader of in the simulation-based education on hospital emergency care.…”

“…Therefore specific operation methods of simulation-based education, such as role assignment [15,16] and numbers of the simulation-exposures [15,17,18], are factors to be considered. Traditionally simulation-based educations are composed of student's simulation experience and debriefing.…”