10 Resident Confidence Ratings Reinforce High Proportions of Pediatric and HALO Events in an Emergency Medicine Simulation Curriculum

Abstract

Simulation-based medical education has become a consistent component of emergency medicine residency education, but best practices for frequency and curricular content have not been assessed. Innovations in curriculum delivery and content in trauma and pediatrics have been introduced, with an ongoing need to study the effectiveness of these curricular elements. In addition, no prior studies have investigated the impact of simulated activities on learner confidence as compared to clinical encounters. Our objectives were to create and administer an emergency medicine residency curriculum enriched for HALO and pediatric cases; and subsequently survey residents related to the source of their confidence in caring for this type of patient. The authors developed a novel 18-month simulation curriculum incorporating twice-monthly simulation, interprofessional in situ simulation, and enriched for pediatric and high-acuity, low-occurrence (HALO) cases. This curriculum was implemented twice over a three-year period with minor changes to cases made during the second iteration. Residents in a single academic EM residency program were surveyed after their participation in the curriculum. The survey included 18 Likert scale agree/disagree items as well as scales that encouraged the resident to assign their confidence with specific case-types to either clinical (0) or simulation (100) experiences, with equally both (50) in the middle. Source of confidence questions included the following topics: Managing a team; leading a successful code; common presentations; rare presentations (HALO); pediatric emergencies; obstetrical emergencies; and ENT emergencies. The overall curriculum over a single 18-month period included 91 cases, including 19 (21%) HALO and 20 (22%) pediatric cases. Of the total, 39 (42%) were in-situ and interprofessional and 6 (7%) were procedure-based. Thirty- one current and former emergency medicine residents responded to the curricular survey. Of these, 8 were PGY1 (25.8%), 6 PGY2 (19.4%), 8 PGY3 (25.8%), and 9 were first-year attendings (29%). Residents reported that simulation contributed more to their confidence in pediatric (75, 95% CI: 53.2- 98) and HALO (78, 95% CI: 36.35- 93.95) clinical cases than clinical experiences. Residents attributed their confidence in common clinical cases to clinical experience over simulation (36.5, 95% CI: 10.9- 78.4). Residents derive a significant portion of their acute pediatric and HALO skills and confidence from simulation cases rather than the clinical setting. Our curriculum enriched for these experiences and the associated survey results reinforce the need to consider including high proportions of these cases in emergency medicine residency programs.