53. PRACTICE MAKES PERFECT: USING REPETITIVE, SMALL-CHANGE SIMULATION FOR EMERGENT PEDIATRIC SCENARIOS

Abstract

Background Simulation is a cornerstone of residency training across disciplines. Studies show repeated exposure to the same case scenario may improve medical decision making, but little is known about how this affects the learning experience. Methods All pediatric residents participate in simulation exercises both in situ and at our state-of-the-art simulation center. Each scenario includes a nurse and parent who are simulated actors, as well as a child mannequin. Residents at all phases of training work in groups of 3-4. Two categories of simulation scenarios were created. The first reviewed management of status epilepticus - one patient with known epilepsy and the second a hypoglycemic child with an insulin overdose. The second category was management of tachycardia - one patient with sepsis and the second with supraventricular tachycardia. The patient's age, weight, overall appearance, and vital signs were identical in each category. Subtle differences in history and physical exam were present, which residents had to elucidate without prompting. Each group performed two different cases with the same chief complaint. Groups were assessed using the Simulation Team Assessment Tool (STAT), a validated tool published in Resuscitation. Results Seven groups of residents participated from July to December 2019 for 14 total cases. The average STAT score for resident teams participating in the first tachycardia case was 13.75/16 (0.86), while the average in the second scenario was 18/18 (1.00). The average STAT score for teams participating in the first seizure case was 12.3/16 (0.77), while the average in the second case was 15.66/18 (0.87). Average resident satisfaction scores were equal across first and second scenarios at 4.85/5. Conclusions Repetitive simulation using subtle differences in history and physical exam allows for an opportunity to practice important life-saving skills for pediatric residents, while also allowing for some variation and avoidance of repetition bias. This format can easily be modified and applied towards other emergent pediatric situations based on learner needs.