Abstract
BackgroundWe sought to develop a low-fidelity simulation-based curriculum for pediatric residents in Rwanda utilizing either rapid cycle deliberate practice (RCDP) or traditional debriefing, and to determine whether RCDP leads to greater improvement in simulation-based performance and in resident confidence compared with traditional debriefing.MethodsPediatric residents at the Centre Hospitalier Universitaire de Kigali (CHUK) were randomly assigned to RCDP or traditional simulation and completed a 6 month-long simulation-based curriculum designed to improve pediatric resuscitation skills. Pre- and post- performance was assessed using a modified version of the Simulation Team Assessment Tool (STAT). Each video-taped simulation was reviewed by two investigators and inter-rater reliability was assessed. Self-confidence in resuscitation, pre- and post-simulation, was assessed by Likert scale survey. Analyses were conducted using parametric and non-parametric testing, ANCOVA and intra-class correlation coefficients (ICC).ResultsThere was a 21% increase in pre- to post-test performance in both groups (p < 0.001), but no difference between groups (mean difference − 0.003%; p 0.94). Inter-rater reliability was exceptional with both pre and post ICCs ≥0.95 (p < 0.001). Overall, self-confidence scores improved from pre to post (24.0 vs. 30.0 respectively, p < 0.001), however, the there was no difference between the RCDP and traditional groups.ConclusionsCompletion of a six-month low-fidelity simulation-based curriculum for pediatric residents in Rwanda led to statistically significant improvement in performance on a simulated resuscitation. RCDP and traditional low-fidelity simulation-based instruction may both be valuable tools to improve resuscitation skills in pediatric residents in resource-limited settings.
Highlights
We sought to develop a low-fidelity simulation-based curriculum for pediatric residents in Rwanda utilizing either rapid cycle deliberate practice (RCDP) or traditional debriefing, and to determine whether RCDP leads to greater improvement in simulation-based performance and in resident confidence compared with traditional debriefing
Our results demonstrate that low fidelity simulation in a resource-limited setting utilizing both traditional debriefing and RCDP as instruction techniques can result in significant improvement in pediatric resident performance on simulated resuscitations
This is one of the first studies demonstrating an effective use of low-fidelity simulation to teach complex resuscitation skills in pediatric residents rather than more basic resuscitation steps such as those taught in Helping Babies Breathe or other simulation-based curricula
Summary
We sought to develop a low-fidelity simulation-based curriculum for pediatric residents in Rwanda utilizing either rapid cycle deliberate practice (RCDP) or traditional debriefing, and to determine whether RCDP leads to greater improvement in simulation-based performance and in resident confidence compared with traditional debriefing. Simulationbased educational interventions have been shown to improve resident knowledge and performance in studies assessing simulation for neonatal and pediatric resuscitations [5,6,7], pediatric airway management [8], and time to initiation of CPR [9]. While these studies were conducted on high-fidelity simulators, there is evidence that low-fidelity simulation can be effective, and that the Rosman et al BMC Medical Education (2019) 19:314 transfer of learning is not dependent on the simulator fidelity [10]. Improving the resuscitation skills of pediatric residents in a global health setting where they are frequently tasked with treating critically ill children has the potential to decrease in-hospital pediatric mortality rates significantly [4, 15]
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