Paediatric Resuscitation Training Research Articles

Effectiveness of simulation-based paediatric cardiopulmonary resuscitation training program among nursing students in Saudi Arabia.

The main objective of this study was to adopt a simulation-based advanced cardiac life support training program to assess nursing students' level of knowledge and practice regarding paediatric advanced cardiac life support and to identify the major knowledge and practice gaps. The methods used in this study were pre-experimental, one group pre and post-test investigation. This study was conducted between September 2022 and November 2022, at the University College of Farasan in the Kingdom of Saudi Arabia. Quantitative data were obtained using the "Cardio Pulmonary Resuscitation Knowledge Questionnaire", "Students' Satisfaction and Self-Confidence Scale," and the "CPR Skill Checklist," which were applied to 75 participants in focus groups. Before the simulation-based CPR training, the students' mean pre-test Paediatric CPR knowledge score was 6.5±2.3 out of 42.0. After the simulation, the mean post-test CPR knowledge score (38.1±2.9) considerably improved (p 0.05). The mean post-test CPR skills score (44.7±1.2) was also considerably higher than the mean pre-test CPR skills score (11.4±2.8) at (p 0.05). Additionally, after the simulation training, students' happiness and confidence levels (61.9±2.2) greatly increased. Themes from the qualitative data showed that the simulation was viewed as an engaging and effective teaching tool by the students. Two themes emerged from the study: "Worries before simulation" and "Satisfaction after simulation". Simulation-based paediatric cardio Pulmonary resuscitation training program has raised nursing students' level of expertise in knowledge, performance, and self-efficacy. Additionally, strong satisfaction and self-confidence levels were discovered following the simulation training.

Rapid cycle deliberate practice versus postsimulation debriefing in pediatric cardiopulmonary resuscitation training:a randomized controlled study

Rapid cycle deliberate practice versus postsimulation debriefing in pediatric cardiopulmonary resuscitation training:a randomized controlled study

A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer

Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each ‘FAIL’ during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly ‘PASSES’ were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann–Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9–10 months; of those achieving competence at month 2, 86% demonstrated competence at 8–9 months; of those participants achieving competence at month 3, 67% retained competence at 7–8 months; for those achieving competence at month 4, 80% demonstrated retention at 6–7 months. Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence.What is Known:• Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training.• Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established.What is New:• Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months.• With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up.

Integrating leadership into interprofessional non-acute care pediatric provider resuscitation training

Due to limited clinical exposure, non-acute care pediatric providers often rely on simulated experiences to maintain resuscitation skills. Few training options designed for the non-acute care setting exist, are often difficult to access, and lack incorporation of non-technical skills. The first five minutes (FFM) is a previously published curriculum designed to train non-acute care providers. The goal of this study was to determine the curriculum's effectiveness during a pilot intervention. A single cohort of multi-professional, non-acute care pediatric providers participated. The primary outcome skill was "establishing leadership," and secondary outcomes included other technical and non-technical skills. Learning of outcome skills was assessed using changes in retrospective pre-post self-assessment Likert scale scores. Differences were compared using paired t-tests and ANOVA. Thirty-seven participants submitted self-assessments. There was improvement in establishing leadership (pre-mean 1.14, post-mean 2.30, P < 0.01), and all other objectives studied. Compared to each other, subgroups of nurses, physicians, and respiratory therapists demonstrated significant differences in learning of technical skills, but similar improvements with non-technical skills. These findings suggest that the FFM curriculum is an effective tool for training non-acute care pediatric providers interprofessional resuscitation skills. Future research should assess provider behavioral changes, retention of training requirements, and patient outcomes. Traditional resuscitation education programs focus largely, or entirely, on performance of technical skills and algorithmic actions. However, non-technical skills, such as leadership, are crucial to the overall success of resuscitation efforts. The FFM program was developed to incorporate leadership principles into the resuscitation education of non-acute care pediatric inpatient providers, and this curricular evaluation suggests that improvements in participant leadership skills occurred due to the program.

A phenomenological study of the use of 360° Virtual Reality (VR) video in pediatric and neonatal resuscitation training

A phenomenological study of the use of 360° Virtual Reality (VR) video in pediatric and neonatal resuscitation training

Evaluating Knowledge Level of the Medical Students about Children Cardiopulmonary Resuscitation in Aliebne University of Medical Science

Introduction: Awareness of pediatric cardiopulmonary resuscitation (CPR) is obligatory for every graduated medical student. In fact, only correct and effective Cardiopulmonary resuscitation can increase the survival rate of patients with cardiopulmonary arrest and since CPR techniques and maneuvers should be done in a specific way for children, it is important to evaluate the knowledge of pediatric resuscitation.&#x0D; Methods: In a cross-sectional study, multiple-choice questions were designed about basic and advanced pediatric cardiopulmonary resusitation (under 8 years) and 100 medical students enrolled in undergraduate training. Results were analyzed using the software SPSS 15.&#x0D; Results: The interns' advanced awareness was significantly less than the basic knowledge (P-Value &lt; 0.001). The awareness of students who studied in CPR was higher than students who did not (P-Value &lt; 0.027). Moreover, students who participated in the rehabilitation of children were more aware (P-Value &lt; 0.002) and interns who attended the Heart Ward had a higher level of awareness (P-Value &lt; 0.001).&#x0D; Conclusion: In general, results obtained from the interns' awareness in the present showed the importance of pediatric resuscitation training courses and participation in resuscitation operations. So, this training course should be considered as a training strategy course in the internship program.

Peer-led pediatric resuscitation training: effects on self-efficacy and skill performance

BackgroundPeer-led basic life support training in medical school may be an effective and valued way of teaching medical students, yet no research has been conducted to evaluate the effect on the self-efficacy of medical students. High self-efficacy stimulates healthcare professionals to initiate and continue basic life support despite challenges.MethodsA randomized controlled trial, in which medical students received pediatric basic life support (PBLS) training, provided by either near-peer instructors or expert instructors. The students were randomly assigned to the near-peer instructor group (n = 105) or expert instructor group (n = 108). All students received two hours of PBLS training in groups of approximately 15 students. Directly after this training, self-efficacy was assessed with a newly developed questionnaire, based on a validated scoring tool. A week after each training session, students performed a practical PBLS exam and completed another questionnaire to evaluate skill performance and self-efficacy, respectively.ResultsStudents trained by near-peers scored significantly higher on self-efficacy regarding all aspects of PBLS. Theoretical education and instructor feedback were equally valued in both groups. The scores for the practical PBLS exam and the percentage of students passing the exam were similar in both groups.ConclusionsOur findings point towards the fact that near-peer-trained medical students can develop a higher level of PBLS-related self-efficacy than expert-trained students, with comparable PBLS skills in both training groups. The exact relationship between peer teaching and self-efficacy and between self-efficacy and the quality of real-life pediatric resuscitation should be further explored.Trial registrationISRCTN, ISRCTN69038759. Registered December 12th, 2019 – Retrospectively registered.

Effects of Feedback on Chest Compression Quality: A Randomized Simulation Study.

Our aim for this study was to test whether visual and verbal feedback compared with instructor-led feedback improve the quality of pediatric cardiopulmonary resuscitation (CPR). There were 653 third-year medical students randomly assigned to practice pediatric CPR on 1 of 2 manikins (infant and adolescent; n = 344 and n = 309, respectively). They were further randomly assigned to 1 of 3 feedback groups: The instructor feedback (IF) group (n = 225) received traditional, instructor-led feedback without any additional feedback device. The device feedback (DF) group (n = 223) received real-time visual feedback from a feedback device. The instructor and device feedback (IDF) group (n = 205) received verbal feedback from an instructor who continuously reviewed the trainees' performance using the feedback device. After the training, participants' CPR performance was assessed on the same manikin while no feedback was being provided. For the primary outcome of total compression score, participants in the DF and IDF groups performed similarly, with both groups showing scores significantly (P < .001) better than those of the IF group. The same findings held for correct hand position and the proportion of complete release. For compression rate, the DF group was at the higher end of the guideline for 100 to 120 chest compressions per minute compared with the IF and IDF groups (both P < .001). No effect of feedback on compression depth was found. Chest compression performance significantly improved with both visual and verbal feedback compared with instructor-led feedback. Feedback devices should be implemented during pediatric resuscitation training to improve resuscitation performance.

Knowledge Accrual Following Participation in Pediatric Fundamental Critical Care Support Course in Gaborone, Botswana*

To describe provider characteristics, knowledge acquisition, perceived relevance, and instruction quality of the Society of Critical Care Medicine's Pediatric Fundamentals of Critical Care Support course pilot implementation in Botswana. Observational, single center. Academic, upper middle-income country. Healthcare providers in Botswana. A cohort of healthcare providers completed the standard 2-day Pediatric Fundamentals of Critical Care Support course and qualitative survey during the course. Cognitive knowledge was assessed prior to and immediately following training using standard Pediatric Fundamentals of Critical Care Support multiple choice questionnaires. Data analysis used Fisher exact, chi-square, paired t test, and Wilcoxon rank-sum where appropriate. There was a significant increase in overall multiple choice questionnaires scores after training (mean 67% vs 77%; p < 0.001). Early career providers had significantly lower mean baseline scores (56% vs 71%; p < 0.01), greater knowledge acquisition (17% vs 7%; p < 0.02), but no difference in posttraining scores (73% vs 78%; p = 0.13) compared with more senior providers. Recent pediatric resuscitation or emergency training did not significantly impact baseline scores, posttraining scores, or decrease knowledge acquisition. Eighty-eight percent of providers perceived the course was highly relevant to their clinical practice, but only 71% reported the course equipment was similar to their current workplace. Pediatric Fundamentals of Critical Care Support training significantly increased provider knowledge to care for hospitalized seriously ill or injured children in Botswana. Knowledge accrual is most significant among early career providers and is not limited by previous pediatric resuscitation or emergency training. Further contextualization of the course to use equipment relevant to providers work environment may increase the value of training.

Basic and immediate paediatric cardiopulmonary resuscitation training in medical students

Abstract Background To analyse the effectiveness of Paediatric Basic Life Support (PBLS) and Paediatric Immediate Life Support (PILS) courses to train medical students in paediatric cardiopulmonary resuscitation (CPR). Methods Eighteen courses (13 in PBLS and 5 in PILS) were delivered to 1214 medical students. Two theory tests and one practical test were performed. Students filled in an anonymous questionnaire after each course. Results The mean scores (out of 20) in the theory tests of the PBLS course were 11.4 before the course, and 19.2 upon completion (P Conclusions PBLS and PILS courses are useful methods for delivering theory and practice training to medical students, and should be mandatory in the paediatric curriculum of medical studies.

The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session.

Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation.

Pediatric Trauma: Management From an Austere Prospective.

Pediatric trauma represents a notable proportion of casualties encountered by Combat medics, physician assistants, and physicians while in the deployed setting. Most of these resuscitation teams receive limited pediatric- specific training and suffer subsequent emotional stress due the perceived high-stakes nature of caring for gravely wounded children. Even when children survive long enough to arrive at combat support hospitals, there remain high risks for morbidity and mortality for many of them. There are numerous reports of the epidemiological characteristics of these pediatric patients, the common mechanisms of injury, the hospital lengths of stay, and calls for pediatric-specific equipment and specialist presence in-theatre. There is scant literature, however, on child-specific battlefield resuscitation and training for initial providers, and we believe that, with appropriately tailored pediatric resuscitation education and training strategies, there is some potential for a reduction in the morbidity and mortality associated with childhood combat injury.

Definitions and Assessment Approaches for Emergency Medical Services for Children.

Pediatric Life Support (PLS) courses and instructional programs are educational tools developed to teach resuscitation and stabilization of children who are critically ill or injured. A number of PLS courses have been developed by national professional organizations for different health care providers (eg, pediatricians, emergency physicians, other physicians, prehospital professionals, pediatric and emergency advanced practice nurses, physician assistants). PLS courses and programs have attempted to clarify and standardize assessment and treatment approaches for clinical practice in emergency, trauma, and critical care. Although the effectiveness of PLS education has not yet been scientifically validated, the courses and programs have significantly expanded pediatric resuscitation training throughout the United States and internationally. Variability in terminology and in assessment components used in education and training among PLS courses has the potential to create confusion among target groups and in how experts train educators and learners to teach and practice pediatric emergency, trauma, and critical care. It is critical that all educators use standard terminology and patient assessment to address potential or actual conflicts regarding patient evaluation and treatment. This article provides a consensus of several organizations as to the proper order and terminology for pediatric patient assessment. The Supplemental Information provides definitions for terms and nomenclature used in pediatric resuscitation and life support courses.

乳児心肺蘇生シミュレーション実習にて習得した技能の経時的変化(The changes in CPR skills with time learned in an infantile simulation–based resuscitation training)

【背景】小児科医が蘇生事象に立ち会う頻度は低く，対応し得る技能の習得にはoff–the–job trainingが必要である。しかし，習得方法や再履修の時期は明らかではない。【目的】シミュレーション実習で習得した技能の経時的変化を評価し，技能維持に必要な再履修を考慮した効果的な蘇生教育プログラムを立案する。【対象】国立成育医療研究センター 2009年度新規採用レジデント18名（集中治療科6名および総合診療部12名）を対象とした。【方法】乳児心停止例を想定した4か月間のシミュレーション実習を施行した。対象者は，1か月に1度以上の頻度で実習に参加し，中央値2±0回のチームリーダー役を担当した。習得した技能の定量評価として，乳児の心室細動を想定した実技試験でBLSおよびALSの各手技実施までの時間を計測し，実習前・実習直後・実習終了後から4か月・8か月での変化を検討した。【結果】BLS手技の人工呼吸と胸骨圧迫は実習前後で，それぞれ51→31秒（中央値），65→38秒（同）に有意に改善した（p<0.05）。しかし，実習終了後から4か月以降には60秒以内に実施できない者がいた。ALS手技の除細動の完了時間は，実習直後の160秒（中央値），その4か月後は189秒（同）で，有意に遅延していた（p<0.05）。また，蘇生事象に立ち会う頻度が少ない総合診療部レジデントは，頻度の高い集中治療科レジデントより技能が経時的に悪化する傾向があった。【結語】実習により習得した蘇生技能は経時的に減衰し，蘇生事象に携わる機会の乏しい医療従事者で顕著であった。技能維持には一般的な蘇生コースが求めている2年に1度の再履修では不充分であると考えられた。しかし，再履修を実技講習で頻回に行うことは容易ではなく，今後はe–learning等の役割に関する検討をしていきたい。 Background: Because of infrequent pediatric cases of cardiopulmonary arrest (CPA), off–the–job training for cardiopulmonary resuscitation (CPR) skills is essential for pediatricians. However, the optimal method and the appropriate timing for refresher training are not clear. Objectives: The purpose of this study was to evaluate the change in CPR skills of pediatric residents with time, and to establish an effective education program to retain CPR skills. Subjects: Eighteen newly hired residents (six in critical care medicine and 12 general pediatrics) at the National Medical Center for Children and Mothers in 2009 were included in the study. Methods: Participants received simulation–based pediatric resuscitation training for 4 months. Participants received training at least once per month and were assigned to perform CPR as a leader (median = 2±0 times) during the training period. The CPR skills of participants were quantitatively evaluated by a simulation–based test that measured the time required prior to resuscitative interventions of basic life support (BLS) and advanced cardiac life support (ACLS). We used a scenario of ventricular fibrillation in an infant and examined the change in CPR skills immediately after training and at 4 and 8 months after training. Results: There was significant improvement in the median duration of BLS skills immediately after the training, from 51s to 31s for ventilation and from 65s to 38s for chest compression (p<0.05). However, several residents could not perform BLS skills (ventilation and chest compression) in 60s at 4 and 8 months after the training. Defibrillation skill showed significant decline at 4 months after training compared with the skill immediately after training (from 160s to 189s, p<0.05). Decline of CPR skills was more apparent in general pediatrics residents than in critical care medicine residents, who performed pediatric CPR more frequently. Conclusions: The CPR skills learned and acquired in a simulation–based resuscitation training declined with time and the decline was apparent in residents who performed CPR infrequently. Refresher training every 2 years may be inadequate for retention of CPR skills, but it appears difficult to perform simulation refresher training more frequently. Further study is required to evaluate other retraining methods such as e–learning. 小児の心肺停止は成人と比較して発生頻度が少ないため 1，診療のなかで蘇生の技能を習得することは困難である。そのため小児蘇生のoff–the–job trainingは重要であり，Pediatric Advanced Life Support（PALS）プロバイダーコースなどのシミュレーション教育の有効性が示唆されている 2, 3。しかし，習得した知識と技能の経時的な減衰も報告されており 4, 5，効果的な蘇生教育プログラムは技能を習得させるとともに，その技能を維持させることが求められる。そのためPALSプロバイダーコースでは2年間に1度の再履修により，技能維持を図っている。しかし，技能維持に必要な再履修の頻度や方法は明らかではない。 シミュレーション実習にて習得した乳児二次救命処置における技能の経時的変化を評価し，技能維持に必要な再履修の蘇生教育プログラムを立案する。 国立成育医療研究センター 2009年度新規採用レジデント 集中治療科6名および総合診療科12名の計18名を対象とした。集中治療科レジデントは，初期研修修了かつ後期研修を1年以上経験していることを条件に採用され，主な業務は小児集中治療室における重症患者の診療である。一方，総合診療科は初期研修修了を条件に採用され，主な業務は一般病棟での診療である。当施設では，以前より集中治療科と総合診療科のレジデントに対して蘇生教育を行ってきており，今回の研究の対象に選定した。 乳児心停止例を想定した4か月間のシミュレーション実習を施行した後に実技試験を行い，シミュレーション実習の前，直後，実習終了後から4か月後，8か月後に習得した技能の経時的変化を評価した。 4か月間 実習前，実習終了後，実習終了後から4か月，8か月 R（The R foundation for Statistical Computing, Vienna, Austria, version 2.13.0）を医療統計用にカスタマイズしたEZR（自治医科大学埼玉医療センター；http://www.jichi.ac.jp/saitama–sct/SaitamaHP.files/statmed.html）を用いた。習得した技能の経時的変化にはFriedman検定（対応のある3群以上の間の比較）を用い，Holm法にて多重比較における有意確率の調整を行った。 対象レジデント18名（集中治療科6名，総合診療科12名）の医師経験年数は，中央値3±1.5年であった（Table 1）。総合診療科レジデントの多く（9/12名）は初期研修終了直後であり，小児心肺蘇生事象の経験は，中央値1±1回と少なかった。対象全員がPALSプロバイダーコースを受講していたが，その受講後期間は受講1か月後から4年以上経過と広い幅を認めた。対象レジデントは，1か月に1度以上の頻度で中央値5±0.5回実習に参加し，中央値2±0回のリーダー役を担当した。当直業務や診療上の都合で実習当日に参加できないことが判明することもあり，実習参加回数およびリーダー役の回数に幅が生じた。 実習前後で両方の手技を実施するまでの時間は有意に改善した（Fig. 1）。実習後には有意な経時的悪化はみられなかったが，実習直後には全員が約60秒以内に両方の手技を実施できていたにも関わらず，実習終了後から4か月以降には60秒以内に実施できない者があった。60秒以内に実施できなかった者は，人工呼吸では実習終了後から4か月で1名，8か月で2名，胸骨圧迫では実習終了後から4か月で2名，8か月で6名と増加傾向にあった。 Changes with time of CPR skills. Time required to perform each skill of basic life support (BLS) and advanced cardiac life support (ACLS) is shown. 実習直後には全員が実施できたが，実施までの時間に有意な改善はなかった（Fig. 1）。実習後の経時的変化では，実習終了後から4か月より有意な悪化を認め，4か月には3人（17%），8か月には5人（28%）が7分間の実技試験中に除細動を実施できなかった。 実習直後には非実施率が61%から22%に改善したが，実施までの時間に有意な改善はなかった（Fig. 1）。実習後の経時的変化では，非実施率および実施までの時間に変化を認めなかった。 蘇生事象に立ち会う頻度の高い集中治療科レジデント（n=6）と，一般小児の診療にあたることが多い総合診療科レジデント（n=12）の経時的変化を比較した。総合診療科レジデントの除細動実施までに要した時間は，実習終了後から8か月には統計学的に有意に悪化した。BLSおよびALSの各手技施行までの時間は，総合診療科レジデントにおいて悪化する傾向があったが，集中治療科レジデントに一定の傾向は認めなかった（Fig. 2）。 Changes with time of CPR skills (a comparison of general pediatrics and critical care medicine residents). Time required to perform each skill of basic life support (BLS) and advanced cardiac life support (ACLS) is shown in each group. 効果的な蘇生教育プログラムには，技能維持に必要な再履修の時期を考慮する必要がある。過去の報告では技能の評価として，実技試験による処置実施の有無やその質が評価されてきたが，時間の要素に関する評価はほとんどなされていない 7。心停止症例の転帰改善には適切かつ迅速な介入が重要であり 8, 9，今回我々はBLSおよびALSの各手技実施までの時間を用いて，シミュレーション実習にて習得した技能の経時的変化を評価した。 本研究の結果，ALSの手技である除細動実施までの時間は経時的に遅延することがわかった。BLSの手技は経時的な悪化はみられなかったものの，実習直後には全員が60秒以内に両方の手技を実施できたが，実習終了後から4か月以降には60秒以内に実施できない者があった。また，集中治療科レジデント（n=6）より総合診療科レジデント（n=12）において技能が経時的に悪化する傾向があった。当施設では，集中治療科レジデントは小児集中治療室と一般病棟での蘇生事象に対応するのに対し，総合診療科では主に一般病棟において一般小児診療を行っている。そのため蘇生事象の臨床経験に差が生じ，実習後の技能維持に影響した可能性が考えられた。 Smithら 5は，133名の看護師を対象としたBLSとALSに対する知識と技能の維持を筆記試験と実技試験にて評価した。実習終了後から3か月にはBLS，ALSともに悪化したが，知識と比較して技能が，BLSと比較してALSがより早期に悪化したと報告している。Yangら 7は，ALSの知識と技術の維持に関するシステマティックレビュー（11編の文献）の中で，ALS技能の低下は平均して実習終了後から6～12か月には生じるが，実習前または実習後に蘇生事象の臨床経験があるとALSの技能が維持される傾向があったと報告している。今回，我々は乳児蘇生におけるBLSおよびALSの各手技実施までに要した時間という新たな評価概念にて経時的変化を検討した。Smithら 5およびYangら 7の報告は成人の蘇生について述べてはいるが，実技試験による処置実施の有無やその質の経時変化は我々の研究と同様の結果であった。すなわち，BLSおよびALSの技能は低下するものであり，その低下は特に蘇生事象の経験がないもので顕著である。そのため，蘇生事象に携わる機会の乏しい医療従事者は，その技能を維持するための再履修が必要である。 では，適切な再履修はどのくらいの頻度で行えばよいのであろうか？この質問に対する明確な回答はないが，少なくとも一般的な蘇生コースが求めている2年に1度の再履修では不充分であると考えられている 7。Berdenら 10は，3か月および6か月毎に再履修した群は技能を維持したが，12か月毎の群では技能を維持できなかったと報告している。我々は，過去の報告から技能が減衰してくると推測される実習終了後から6～12か月 7よりも早期の，実習終了後から4か月，8か月の時点で経時的変化を評価した。我々の結果では実習終了後から4か月にはALSの技能が低下しており，やはり過去の報告と同様に2年に1度の再履修では不充分であると考えられた。 しかし，再履修を実技講習で頻回に行うには，場所，時間，費用，人員確保などの問題があり困難であることが多い。DVDやインターネットなどの情報技術を用いて教育を行うe–learningを取り入れるなど，再履修の問題を解決する方法を検討する必要があり，今後の重要な課題である。 本研究の限界としては，追跡期間が実習終了後から8か月と短期間である点，評価期間中の臨床経験をレジデントの所属のみで評価している点，また過去の臨床経験の影響を検討していない点が挙げられる。また，今回評価をしたBLSとALSの各手技実施までの時間の先行研究は乏しく，各手技の理想的な達成時間は明確に定められておらずシミュレーション実習の効果自体を適切に評価できていない可能性もある。なお，本研究はAHAガイドラインに準拠し実習を行っているが，4か月間にわたる独自のoff–the–job trainingであり，PALSなど短期間の定型的な訓練コースと必ずしも比較できるものではない。 シミュレーション実習により習得した蘇生技能は実習後に経時的な減衰を認め，蘇生事象に携わる機会の乏しい医療従事者において顕著であった。習得した技能を維持するためには一般的な蘇生コースが求めている2年に1度の再履修では不充分であると考えられた。再履修を実技講習で頻回に行うことは容易ではなく，技能維持に果たすe–learning等の利用を検討していきたい。 謝辞：ご協力を頂いた国立成育医療研究センター 集中治療科スタッフならびにシニアレジデントの皆様，シミュレーション実習にご参加頂いた総合診療部および集中治療科の新規レジデントの皆様に深く感謝を致します。 日本救急医学会の定める利益相反に関する開示事項はありません。

G574(P) Improving patient care through paediatric simulation and multi-disciplinary resuscitation training based upon previous serious incidents at a district general hospital

Context The quality improvement project was undertaken at a District General Hospital and included staff who care for seriously sick or injured children including doctors and nurses working in general paediatrics, accident and emergency and anaesthetics. The appropriate initial assessment and resuscitation of serious ill and injured children together with on-going reassessment and emergency management are essential for reducing morbidity and mortality. Problem There was no integrated multi-disciplinary team (MDT) paediatric resuscitation training and several paediatric serious incidents had involved more than one department. Simulation training increases the acquisition of skills and provides a platform to review performance and make errors without compromising patient safety. Both the Department of Health and RCPCH recognise the importance of simulation training in improving patient safety through reducing human and system errors. High fidelity manikins can be monitored which significantly adds to their realism. Assessment of problem and analysis of its causes A retrospective review was undertaken by a paediatric trainee of all the paediatric serious incidents during a ten year period to identify common themes and key recommendations. The development of MDT resuscitation training was one of the principle recommendations to improve the emergency assessment and care provided to children. Intervention MDT paediatric resuscitation training sessions involving healthcare assistants, nurses, doctors and other allied healthcare professionals from general paediatrics, accident and emergency and anaesthetics were planned several months in advance through a consultation process. Dates and times were chosen to maximise trainee availability and minimise disruption to routine services. For MDT training in accident and emergency, strategies were implemented to ensure patient safety at all times. Resuscitation officers provided support and resuscitation equipment. The hospital switch board was notified so a simulated paediatric crash call could be initiated through the hospital paging system. Scenarios were developed based upon previous paediatric serious incidents to review whether key recommendations had been successfully implemented and sustained. The focus was on familiarisation with paediatric resuscitation equipment, drugs and guidelines in real time as well as teamwork, communication and leadership skills and dynamics between and within the different specialties. A pilot paediatric simulation MDT training session was also undertaken in the Education Centre. Strategy for change MDT paediatric resuscitation training was coordinated through the paediatric and emergency departments as well as the hospital resuscitation committee. Anonymous feedback through questionnaires was collected from participants. Measurement of improvement The MDT paediatric resuscitation and simulation training received very positive feedback: Excellent scenario, felt more real than other simulated scenarios I have attended. Participants found the MDT simulation training much more realistic than weekly departmental resuscitation training with 79% strongly recommending the simulation training compared with just 33% for the weekly departmental training. Effects of changes MDT paediatric resuscitation training was successfully implemented. A business case was developed for the purchase of a paediatric simulation manikin to improve the reality of the training. Lessons learnt MDT paediatric resuscitation training is a very valuable tool for improving teamwork and paediatric resuscitation skills. Paediatric high fidelity simulation training can enhance this further through providing a more realistic experience. Message for others MDT resuscitation training should be routine practice in district general hospitals. Basing scenarios on previous serious incidents is a useful way to review previous key recommendations. A business case can be developed by demonstrating improved experience through a pilot high fidelity simulation trainer.

The role of simulation in teaching pediatric resuscitation: current perspectives.

The use of simulation for teaching the knowledge, skills, and behaviors necessary for effective pediatric resuscitation has seen widespread growth and adoption across pediatric institutions. In this paper, we describe the application of simulation in pediatric resuscitation training and review the evidence for the use of simulation in neonatal resuscitation, pediatric advanced life support, procedural skills training, and crisis resource management training. We also highlight studies supporting several key instructional design elements that enhance learning, including the use of high-fidelity simulation, distributed practice, deliberate practice, feedback, and debriefing. Simulation-based training is an effective modality for teaching pediatric resuscitation concepts. Current literature has revealed some research gaps in simulation-based education, which could indicate the direction for the future of pediatric resuscitation research.

Impact of contextualized pediatric resuscitation training on pediatric healthcare providers in Botswana

BackgroundWorldwide, 6.6 million children die each year, partly due to a failure to recognize and treat acutely ill children. Programs that improve provider recognition and treatment initiation may improve child survival. ObjectivesDescribe provider characteristics and hospital resources during a contextualized pediatric resuscitation training program in Botswana and determine if training impacts provider knowledge retention. Design/methodsThe American Heart Association's Pediatric Emergency Assessment Recognition and Stabilization (PEARS) course was contextualized to Botswana resources and practice guidelines in this observational study. A cohort of facility-based nurses (FBN) was assessed prior to and 1-month following training. Survey tools assessed provider characteristics, cognitive knowledge and confidence and hospital pediatric resources. Data analysis utilized Fisher's exact, Chi-square, Wilcoxon rank-sum and linear regression where appropriate. Results61 healthcare providers (89% FBNs, 11% physicians) successfully completed PEARS training. Referral facilities had more pediatric specific equipment and high-flow oxygen. Median frequency of pediatric resuscitation was higher in referral compared to district level FBN's (5 [3,10] vs. 2 [1,3] p=0.007). While 50% of FBN's had previous resuscitation training, none was pediatric specific. Median provider confidence improved significantly after training (3.8/5 vs. 4.7/5, p<0.001), as did knowledge of correct management of acute pneumonia and diarrhea (44% vs. 100%, p<0.001, 6% vs. 67%, p<0.001, respectively). ConclusionFBN's in Botswana report frequent resuscitation of ill children but low baseline training. Provider knowledge for recognition and initial treatment of respiratory distress and shock is low. Contextualized training significantly increased FBN provider confidence and knowledge retention 1-month after training.

Pediatric resuscitation training—Instruction all at once or spaced over time?

AimHealthcare providers demonstrate limited retention of knowledge and skills in the months following completion of a resuscitation course. Resuscitation courses are typically taught in a massed format (over 1–2 days) however studies in education psychology have suggested that spacing training may result in improved learning and retention. Our study explored the impact of spaced instruction compared to traditional massed instruction on learner knowledge and pediatric resuscitation skills. MethodsMedical students completed a pediatric resuscitation course in either a spaced or massed format. Four weeks following course completion students completed a knowledge exam and blinded observers used expert-developed checklists to assess student performance of three skills (bag-valve mask ventilation (BVMV), intra-osseous insertion (IOI) and chest compressions (CC)). ResultsForty-five out of 48 students completed the study protocol. Students in both groups had similar scores on the knowledge exam spaced: (37.8±6.1) vs. massed (34.3±7.6)(p<0.09) and overall global rating scale scores for IOI, BVMV and CC; however students in the spaced group also performed critical procedural elements more frequently than those in the massed training group ConclusionLearner knowledge and performance of procedural skills in pediatric resuscitation taught in a spaced format is at least as good as learning in a massed format. Procedures learned in a spaced format may result in better retention of skills when compared to massed training.

Board #242 - Program Innovation Paediatric Preparation Day

Objectives Paediatrics can be inherently stressful for junior doctors, who may have limited Paediatric procedural and resuscitation training. The traditional ‘see one, do one, teach one’ medical approach is no longer acceptable. Technology-enhanced learning is being advocated to improve healthcare quality, patient outcomes, safety and experience. The Royal College of Paediatrics and Child Health (RCPCH) is developing a national strategy to integrate simulation-based learning into Paediatric training. Embracing this, the Yorkshire and Humber School of Paediatrics delivers four simulation-based courses for Paediatric speciality trainees. However, no such training is available for Foundation and GP trainees, who rotate through Paediatrics sharing equal responsibilities. We have developed a regional free one-day course aimed to smooth the transition for Foundation and GP trainees into Paediatric jobs. Our goal is to teach and provide the opportunity to practice core Paediatric procedural and resuscitation skills to enhance trainee and patient safety in Paediatric clinical environments. Description Core Paediatric procedures and resuscitation skills were identified from the RCPCH curriculum. The course encompasses the following key skills: 1) History Taking; 2) Basic Safeguarding; 3) Neonatal Life Support; 4) Paediatric Life Support; 5) Newborn Examination; 6) Prescribing; 7) Cannulation and Venesection; and 8) Lumbar Puncture. This one-day pilot course will be delivered by a faculty of Paediatric Simulation Fellows at three regional simulation facilities across Yorkshire. The programme includes a variety of teaching approaches including lectures, small group work and procedural task trainers. Following invitation via the speciality eportfolio, four courses catering for 76 candidates are fully booked. All courses are scheduled for up to six weeks in advance of Paediatric rotation commencement. Qualitative evaluation using Likert scales will be employed to facilitate course analysis using a pre- and post-intervention design. Delegates will be asked to complete knowledge-based questionnaires at the start and at the end of the day to objectively assess learning. Conclusion Data will be analysed to identify the difference between candidate confidence and knowledge pre- and post-course. We will be looking for statistical significance using Chi squared test. This course should prepare Foundation and GP doctors for the practical aspects of a Paediatrics job, facilitate quicker and smoother clinical transition and benefit patients and other healthcare professionals. Following pilot course evaluation, we aim to further develop the course and provide regular course availability for all Foundation and GP trainees rotating into Paediatrics throughout the academic year.

ABSTRACT 870

Background and aims: The Utsteyn formula of survival is teaching that survival = science x medical education x LOCAL education. Have we really implemented pediatric resuscitation training using classical and simulation way of performance?. Aims: Since 70s American Academy of Pediatrics is running Pediatric emergency course, which gave start to several national and international courses. Do we have a clear idea what we are teaching between traditional and simulation based courses? The aim of this abstrat is to discuss what we are doing during teaching. Methods: Revision of 15 year experience on pediatric resuscitation courses in a well defined region studying the approach by EXPRESS-simulation study group to bring classical pediatric resuscitation training towards tools of simulation as structured debriefing. A 2 years periode from 2011 to 2013 has been studied in Europe. Different simulation tolols has been evaluated. Video-introduction of clinical cases are very helpful to enter in scenario training. Virtual vitalparameter patient monitors are powerfull means to enhance realism. Realistic heart- and lung sounds bring Pediatric simulation training closer to clinical practice. Results: This is an ongoing study. We are collecting data to show, that simulation- and Pals-Training can be adapted to original pediatric approach to patient: clinical assessment, monitoring and auscultation as in real life of pediatrician inside and outside of hospital from rural environments to PICU. Conclusions: It seems that our approach after 2 courses is on a good way to combine pediatric practice with selected simulation teaching tools. Ongoing results will be published on www.provinz.bz.it/se/paednotmed . More trial centers are wished.