163. Outside The Comfort Zone: Evaluation of A Simulation-Based Curriculum In Managing Agitated Patients For Paediatric Residents

Abstract

Given the high prevalence of mental health co-morbidity in the paediatric population, it is important that paediatricians and paediatric trainees are trained and competent in the management of acute psychiatric emergencies, including agitation. Experiential learning through simulation is frequently used for safety training in fields where high-risk decisions must be made safely and rapidly. The use of simulation-based training in the management of acutely agitated patients has been studied in the context of psychiatric training programs; however, limited studies exist to inform the most effective method of training paediatric residents in the management of agitated patients. This study assessed the impact of a simulation-based workshop on the knowledge, competence and confidence of paediatric trainees in the management of agitated patients compared to the use of a didactic lecture or no formal educational intervention. Residents enrolled in the Core Paediatrics training program at the Hospital for Sick Children in Toronto, Canada were divided among three study groups; Group 1 - a 1-hour academic half-day lecture on agitation management; Group 2 - a simulation-based workshop on managing an agitated patient; and Group 3 -no intervention. The simulation-based workshop included a didactic component, role-playing and two simulated patient scenarios. Confidence and knowledge were assessed in both the didactic lecture and simulation workshop groups using a pre- and post- intervention self-efficacy questionnaire and an open-ended clinical vignette. All paediatric trainees including those receiving no intervention, completed an agitated patient station as part of their mandatory 2018 in-training Objective Structured Clinical Examination (OSCE) assessment. Examiners evaluating resident performance on the agitated patient OSCE station were blinded to the groups. Examiners assessed resident performance using a station checklist score and global rating score which considers communication skills and general approach/organization. Data was analyzed using means and standard deviations. T-tests were also performed. Average OSCE scores for Groups 1, 2 and 3 were 74.6%, 81.4% and 71.6% respectively. Residents who participated in the simulation-based workshop (Group 2) performed better in the agitated-patient OSCE scenario compared to those who participated in the 1-hour didactic lecture (Group 1) and those who received neither (Group 3). Scores for this scenario did not improve with increased level of training as was seen in other stations, demonstrating a broader knowledge gap. Analysis of clinical vignette and self-efficacy scores will be completed and compared to OSCE performance. Management of acute agitation is a necessary skill for paediatricians which is not being met by current curricular standards. Our project demonstrates that simulation-based learning may be an effective way of filling this important clinical gap.