“When in Doubt, Change It out”: A Case-Based Simulation for Pediatric Residents Caring for Hospitalized Tracheostomy-Dependent Children

Abstract

Introduction: Caring for technology-dependent children, such as those with tracheostomy and ventilator dependence, can be new and frightening for pediatric residents. Education about emergencies in this patient population is important because these children are at risk for in-hospital complications. Safe care of the tracheostomy-dependent child requires the ability to recognize common complications, such as tracheostomy tube obstruction or decannulation, and intervene appropriately by suctioning and/or replacing the tracheostomy tube. This simulation-based curriculum teaches learners to identify and practice the management of these tracheostomy tube complications through low-fidelity simulation exercises. Methods: We created a simulation session with three cases reflecting in-hospital scenarios encountered by resident physicians caring for tracheostomy-dependent children in the inpatient setting. The simulation scenario, simulation environment preparation, materials list, and debriefing outline are provided for the instructor for each simulation case. Validity evidence for the assessment tool was obtained by calculating the interrater reliability of two different raters. Resident feedback was obtained through anonymous surveys. Results: Twelve pediatric senior residents completed the experience. It received overwhelmingly positive feedback on learner evaluation forms, with 90% finding the experience very or extremely helpful. The intraclass correlation coefficient of interrater reliability for our assessment tool was 0.93. Discussion: The simulation was well received by residents. The interrater reliability was acceptable. This low-fidelity simulation exercise can easily be executed with minimal materials or instructor training. High-yield, just-in-time training with postcase debriefing is key to the simulation's success.

Chronic tracheostomy care of ventilator‐dependent and ‐independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system

“…The majority of institutions are employing low fidelity simulation (13/16, 75%) as mentioned in the ATS guideline on children with chronic tracheostomy, while a minority employ high fidelity simulation (1/16, 6%) 16 . While there is some evidence of the use of low fidelity simulation in the training of health care providers both at home and in‐hospital in the care of tracheostomy‐dependent patients, there is a paucity of literature assessing the impact of low fidelity training on family caregiver competence 22,23 . Conversely, high fidelity simulation training as part of a tracheostomy education program for family caregivers was found to be acceptable and to increase caregiver confidence in managing tracheostomy care and related emergencies 24–26 .…”

Pediatric Resident Education in Pulmonary (PREP): A Subspecialty Preparatory Boot Camp Curriculum for Pediatric Residents

“…A 60-minute hands-on low-fidelity simulation activity by Khan et al 16 was downloaded from MedEdPORTAL for implementation. The simulation included three scenarios of acute inpatient events in the TV-dependent patient.…”

Tracheotomy care simulation training program for inpatient providers

“… 9 , 10 , 11 Better results have been demonstrated with instructor‐guided simulation, including programs on tracheotomy care education. 12 , 13 , 14 , 15 , 16 , 17 , 18 However, because instructor‐led simulation is time intensive and incorporating high‐fidelity mannequins can be costly, generalized use of these modalities is limited. This, coupled with the relative infrequency of airway complications, may contribute to the fact that knowledge, competence, and confidence with urgent and emergent airway and tracheotomy scenarios among non‐otolaryngology providers remains poor.…”

“…However, lecture‐style learning and review of written material in isolation can carry the limitation of reduced learner engagement and retention 9–11 . Better results have been demonstrated with instructor‐guided simulation, including programs on tracheotomy care education 12–18 . However, because instructor‐led simulation is time intensive and incorporating high‐fidelity mannequins can be costly, generalized use of these modalities is limited.…”