Using Screen‐Based Simulation to Improve Performance During Pediatric Resuscitation

Abstract

Objectives: To assess the ability of a screen-based simulation-training program to improve emergency medicine and pediatric resident performance in critical pediatric resuscitation knowledge, confidence, and skills.Methods: A pre-post, interventional design was used. Three measures of performance were created and assessed before and after intervention: a written pre-course knowledge examination, a self-efficacy confidence score, and a skills-based high-fidelity simulation code scenario. For the high-fidelity skills assessment, independent physician raters recorded and reviewed subject performance. The intervention consisted of eight screen-based pediatric resuscitation scenarios that subjects had 4 weeks to complete. Upon completion of the scenarios, all three measures were repeated. For the confidence assessment, summary pre-and post-test summary confidence scores were compared using a t-test, and for the skills assessment, pre-scores were compared with post-test measures for each individual using McNemar's chi-square test for paired samples.Results: Twenty-six of 35 (71.3%) enrolled subjects completed the institutional review board-approved study. Increases were observed in written test scores, confidence, and some critical interventions in high-fidelity simulation. The mean improvement in cumulative confidence scores for all residents was 10.1 (SD ±4.9; range 0-19; p < 0.001), with no resident feeling less confident after the intervention. Although overall performance in simulated codes did not change significantly, with average scores of 6.65 (±1.76) to 7.04 (±1.37) out of 9 possible points (p = 0.58), improvement was seen in the administering of appropriate amounts of IV fluids (59-89%, p = 0.03). Conclusions:In this study, improvements in resident knowledge, confidence, and performance of certain skills in simulated pediatric cardiac arrest scenarios suggest that screen-based simulations may be an effective way to enhance resuscitation skills of pediatric providers. These results should be confirmed using a randomized design with an appropriate control group. ACADEMIC EMERGENCY MEDICINE 2009; 16:S71-S75 ª

Improvement of Skills in Cardiopulmonary Resuscitation of Pediatric Residents by Recorded Video Feedbacks

“…Studies have shown that PALS courses improve knowledge [5,6], and enhance pediatric residents' cognitive knowledge but have variable effects on psychomotor skills [7,8]. A few studies have shown improvement of the psychomotor skill of pediatric residents before and immediately after completing a PALS course [9,10]. In 2010, the AHA implemented new PALS guidelines [11].…”

“…Several new training methods have been implemented to improve the confidence, knowledge, competency, or psychomotor skills, including e-learning, screen-based simulation, and video-assisted real time simulation. However, one training method could enhance only some skills [10,12,13]. The authors' institute provides a twoday PALS course for new residents, which includes lectures, skill stations, core case simulation, and mega code stations.…”

Toward a New Paradigm: Goal‐based Residency Training

“…While some of these shortcomings may be training program specific, monitoring the types of resident clinical encounters allows the program director to further tailor the didactic and interactive components of the curriculum to fill in gaps. For example, simulation is useful for teaching high‐acuity, low‐frequency situations such as pediatric resuscitation 15 . While many centers may already be using simulation to teach resuscitation and other high‐acuity events, this study suggests an important need for interactive educational experiences to teach additional skills or concepts that have low or no frequency during training.…”

Residents need focused teaching during pediatric emergency medicine rotation to optimize their educational objectives

“…While many centers may already be using simulation to teach resuscitation and other highacuity events, this study suggests an important need for interactive educational experiences to teach additional skills or concepts that have low or no frequency during training. [20][21][22] The efficacy of an online didactic curriculum in improving knowledge acquisition among non EM, EM rotating residents and medical students during their EM rotations was established. After exposure to an online didactic curriculum, rotating residents demonstrated a significant increase in EM knowledge and reported a high level of satisfaction with the didactic program.…”