The impact of simulation‐based medical education on resident management of emergencies in pediatric anesthesiology

Abstract

Background: Resident education in pediatric anesthesiology is challenging. Traditional curricula for anesthesiology residency programs have included a combination of didactic lectures and mentored clinical service, which can be variable. Limited pediatric medical knowledge, technical inexperience, and heightened resident anxiety further challenge patient care. We developed a pediatric anesthesia simulation-based curriculum to address crises related to hypoxemia and dysrhythmia management in the operating room as an adjunct to traditional didactic and clinical experiences. Aims:The primary objective of this trial was to evaluate the impact of a simulation curriculum designed for anesthesiology residents on their performance during the management of crises in the pediatric operating room. A secondary objective was to compare the retention of learned knowledge by assessment at the eight-week time point during the rotation. Methods:In this prospective, observational trial 30 residents were randomized to receive simulation-based education on four perioperative crises (Laryngospasm, Bronchospasm, Supraventricular Tachycardia (SVT), and Bradycardia) during the first week (Group A) or fifth week (Group B) of an eight-week rotation. Assessment sessions that included two scenarios (Laryngospasm, SVT) were performed in the first week, fifth week, and the eighth week of their rotation for all residents. The residents were assessed in real time and by video review using a 7-point checklist generated by a modified Delphi technique of senior pediatric anesthesiology faculty. Results: Residents in Group A showed improvement between the first week and fifthweek assessment as well as between first week and eighth week assessments without decrement between the fifth week and eighth week assessments for both the laryngospasm and SVT scenarios. Residents in Group B showed improvement between the first week and eighth week assessments for both scenarios and between the fifth week and eighth week assessment for the SVT scenario. Conclusion:This adjunctive simulation-based curriculum enhanced the learner's management of laryngospasm and SVT management and is a reasonable addition to didactic and clinical curricula for anesthesiology residents.

High Rate of Medical Emergency Team Activation in Children with Tracheostomy

“…In addition, other interventions could improve the care of these high-risk patients on the wards. For example, simulation has been successful in improving participants' airway management skills, 43,44 and specifically with regards to tracheostomies, simulation-based education, and skills sessions have been shown to improve nurses' and physicians' knowledge and skills in managing patients with tracheostomies. [45][46][47][48] Future studies are required to determine if enhancing the role of the MET and providing additional targeted education can further enhance the model of care in these patients.…”

Pediatric anesthesia training to early career stage: Opportunities for firm foundations

“…For most trainees in North America, the first exposure to pediatric anesthesia occurs during early years of training corresponding to the Postgraduate Year (PGY)-2 or Clinical Anesthesia (CA)-1 year when first placed in 4-week block rotations. 22,23 The initial weeks of such a rotation can be quite demanding with a steep learning curve. Lack of familiarity with the nuances of complex pediatric patients undergoing unique surgical operations can result in a resident feeling "out a career in pediatric anesthesia, there are several points of focus.…”

“…For most trainees in North America, the first exposure to pediatric anesthesia occurs during early years of training corresponding to the Postgraduate Year (PGY)—2 or Clinical Anesthesia (CA)—1 year when first placed in 4‐week block rotations 22,23 . The initial weeks of such a rotation can be quite demanding with a steep learning curve.…”

Training in pediatric anesthesia in Japan: how should we come along?

“…Recent systematic review indicates that simulation training in anesthesia is at least as good as non-simulator training, and is certainly better than no intervention [33]. There is ongoing enthusiasm for simulation-based training in pediatric anesthesia [34][35][36][37][38][39]. In the era of information technology, telesimulation may provide an alternative method to traditional simulation approaches [40,41], though simulation-based training in anesthesia is fraught with challenges, such as relatively high cost, faculty development, and less tangible patient outcomes [42][43][44][45][46].…”