Pediatric Resuscitation Skills Research Articles

Improvement of Skills in Cardiopulmonary Resuscitation of Pediatric Residents by Recorded Video Feedbacks.

To evaluate the pediatric residents' cardiopulmonary resuscitation (CPR) skills, and their improvements after recorded video feedbacks. Pediatric residents from a university hospital were enrolled. The authors surveyed the level of pediatric resuscitation skill confidence by a questionnaire. Eight psychomotor skills were evaluated individually, including airway, bag-mask ventilation, pulse check, prompt starting and technique of chest compression, high quality CPR, tracheal intubation, intraosseous, and defibrillation. The mock code skills were also evaluated as a team using a high-fidelity mannequin simulator. All the participants attended a concise Pediatric Advanced Life Support (PALS) lecture, and received video-recorded feedback for one hour. They were re-evaluated 6 wk later in the same manner. Thirty-eight residents were enrolled. All the participants had a moderate to high level of confidence in their CPR skills. Over 50% of participants had passed psychomotor skills, except the bag-mask ventilation and intraosseous skills. There was poor correlation between their confidence and passing the psychomotor skills test. After course feedback, the percentage of high quality CPR skill in the second course test was significantly improved (46% to 92%, p=0.008). The pediatric resuscitation course should still remain in the pediatric resident curriculum and should be re-evaluated frequently. Video-recorded feedback on the pitfalls during individual CPR skills and mock code case scenarios could improve short-term psychomotor CPR skills and lead to higher quality CPR performance.

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.

Utilization of a Blended Learning Approach to Teach Pediatric Resuscitation to Medical Residents

Because of the rarity of the event of pediatric resuscitations, residents are not able to practice and maintain skills that are critical for caring for these patients. Training must be focused on rapid decision making, identification of anatomical structures for intubation, selecting appropriate equipment and sizes for resuscitation procedures, selection of appropriate medications and leading a team in stressful situations. The goal of this study was to evaluate the ability of a blended learning approach to facilitate the acquisition and retention of pediatric resuscitation skills utilizing both simulation technology and on-line education resources.

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.

Board #139 - Research Abstract Development of a Multi-Station Assessment of Senior Pediatric Residents (Submission #8630)

Hypothesis The Accreditation Council for Graduate Medical Education (ACGME) has encouraged programs to move away from traditional assessment methodologies, such as faculty assessments and In-Training Examination (ITE), and instead incorporate many types of assessment from a toolbox. Objective Structured Clinical Examinations (OSCEs) may incorporate the use of patient simulators or standardized patients or both. While much of the existing OSCE literature relates to evaluation of medical student performance, there is limited work pertaining to assessment of pediatric residents’ clinical skills. To our knowledge, OSCEs have not been used to assess pediatric residents prior to entering their final year of residency. We developed an OSCE using multiple different testing modalities to assess residents finishing their second year of training. This study aims to describe the process involved in developing the assessment program and to evaluate the tools being used to assess resident performance. Methods Five OSCE cases were developed to assess the residents over the course of an afternoon session. Three cases, focusing on apnea, ventricular tachycardia and status epilepticus, focused on medical management and were performed using high-fidelity simulations. A fourth case involved a patient who had a febrile seizure and was designed specifically to look at a resident giving anticipatory guidance to a standardized parent to examine communication skills. A final case was developed with the idea of assessing residents while they aNew South Walesered pages about various patients and was designed to examine their skills communicating with interns, nurses and consults. Results Assessments were completed annually in the spring from 2012-2014 for all pediatric second-year residents. The first year of the assessment in 2012 was used as a pilot year to develop the cases and assessment tools. The second and third years of the assessment allowed for studies to examine the reliability and validity, as well as further adjustments based on these studies. Tools showed good inter-rater reliability, with an intra-class coefficient above 0.75 for all three tools. Using a generalizability study, checklist tools showed good reliability with one rater for the apnea and status epilepticus cases and two raters for the ventricular tachycardia case. The assessment of the febrile seizure case was changed after the first year to a modified Kalamazoo communication tool. Conclusion The first year of this assessment program was focused on developing case scenarios and assessment tools, as well as looking at feasibility of running the assessment. The assessment required a large amount of staffing and facility time and may not be feasible in other institutions without significant financial and institutional support. The checklist tools for the simulation stations are reasonably reliable and valid, and may be used for assessment of pediatric resident resuscitation skills.

Board #146 - Research Abstract Longitudinal Assessment of Trainees’ Pediatric Code Leadership Through Simulation (Submission #10193)

Hypothesis Pediatric codes are not common, so training opportunities are limited to simulation-based training. Simulation-based pediatric mock code curricula have demonstrated their educational1-2 impact on clinical outcomes.3 A simulation-based Clinical Resuscitation Skills curriculum allows trainees to assume the leadership role during a pediatric code in a safe environment. To assess code leadership skills, an assessment form was created to be completed by the trainee, their peers and a faculty evaluator. We hypothesize mock code simulation with immediate assessment will identify trainee performances gaps to guide timely remediation. Methods This proposal retrospectively reviews the assessments of mid and senior level trainees in pediatric code resuscitation skills from October 2008-December 2012. Participating trainees were either midlevel or senior residents within both Pediatrics and Medicine/Pediatrics programs at our institution. Trainees performed at least 1 mock code during their residency. The majority of the mock codes took place within our Clinical Simulation Center without prior warning to the trainees. A variety of simulation manikins were used for the testing, and scenarios included standard practice of airway skills, rhythm recognition, hemodynamic assessment, and global patient evaluation. The assessment tool consisted of eight items rated on 5-point scales ranging from 1(unacceptable) to 5 (outstanding). A many-facet Rasch model4 was used to compare faculty and residents’ self-reported performance ratings, evaluate learner performance over time, and identify performance differences across trainee level. Results One hundred thirty-seven trainees tested over the four-year period. Results indicated majority of the trainees performed well, but self-reported their performances lower than the evaluator (3.8 vs 4.3, p<0.01). With an increase in frequency and consistency of the mock codes after the first year, significant improvement in the trainee performance was observed (4.2 for 2009 vs 4.4 for 2010-12, p<0.01). The assessment tool was successfully able to differentiate between midlevel and senior residents’ performance with the midlevel residents averaging 4.2 and the senior residents averaging 4.4 (p<0.01). Findings indicated that Med/Peds residents had slightly higher (4.4) averaged scores than Pediatric residents (4.3), p<0.001. Conclusion With the paucity in pediatric codes, simulation is becoming the gold standard in preparing trainees to successfully lead pediatric codes. The assessment tool used in this study adequately measured trainees’ leadership skills. It also differentiated between midlevel and senior residents, and identified trainees who required remediation. This tool can also be for ongoing program evaluation.

Simulation-Based Pediatric Resuscitation Curriculum for Prehospital Providers

OPEN ACCESSNovember 25, 2014Simulation-Based Pediatric Resuscitation Curriculum for Prehospital Providers Cara Doughty, MD, MEd, Nadia Pearson, DO, Juan Mondragon, Jennifer Arnold, MD, Thuy Ngo, DO, Manish Shah, MD Cara Doughty, MD, MEd Baylor College of Medicine Google Scholar More articles by this author , Nadia Pearson, DO United States Army Google Scholar More articles by this author , Juan Mondragon Texas Children's Hospital Google Scholar More articles by this author , Jennifer Arnold, MD Baylor College of Medicine Google Scholar More articles by this author , Thuy Ngo, DO Johns Hopkins University School of Medicine Google Scholar More articles by this author , Manish Shah, MD Baylor College of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9949 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis curriculum was developed to provide didactic and simulation-based education for prehospital providers, such as emergency medical technicians and paramedics, caring for critically ill children in the prehospital environment. The course includes a 75-minute didactic lecture focused on pediatric assessment, three pediatric skills stations highlighting differences between adult and pediatric resuscitation skills, and four high-fidelity scenarios focused on neonatal resuscitation, respiratory distress/failure, seizures, and non-accidental trauma. Each scenario is followed by a debriefing session. This curriculum was developed via collaboration between a consensus group of experts in simulation, medical education, pediatric emergency medicine, prehospital pediatrics, and emergency medical services. After initial curriculum development and instructor training, the curriculum was trialed with emergency medical services providers, and then modified based on their feedback and the feedback of the emergency medical services medical directors. This course has been taught to over 550 prehospital providers since February 2012. Posttest results show significant improvement over pretest scores, and course satisfaction surveys demonstrate extremely high learner satisfaction. Future studies are currently evaluating 6-month retention of knowledge with or without interspersed education, and clinical outcomes for patients of providers trained in this course. Educational Objectives By the end of this session, learners will be able to: Increase prehospital providers awareness and confidence with pediatric evaluation, assessment, and management.Improve communication and teamwork when treating pediatric patients.Increase proficiency when performing pediatric skills and procedures. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Orientation to Simulation.ppt Pedi-STEPPs Pediatric Assessment.pptx Skill Stations Checklists.docx Non-Accidental Trauma Case.docx Scripted Debrief Non-Accidental Trauma.docx Seizure Hypoglycemia Case.docx Scripted Debrief Seizure Hypoglycemia.docx Twin Delivery Case.docx Scripted Debrief Twin Delivery.docx Bronchiolitis Case.docx Scripted Debrief Bronchiolitis.docx ALS TEST.docx BLS TEST.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2014 Doughty et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsPre-hospitalSimulationResuscitationPediatrics Disclosures None to report. Funding/Support None to report. Loading ...

Spaced scenario demonstrations improve knowledge and confidence in pediatric acute illness management.

Objectives: Nationally accredited simulation courses such as advance pediatric life support and pediatric advance life support are recommended for health care professionals (HCPs) at two yearly intervals as a minimum requirement, despite literature evidence suggesting rapid decline in knowledge shortly after course completion. The objective of this study was to evaluate an observation-based, educational intervention program aimed at improving previously acquired knowledge and confidence in managing critical illnesses.Methods: A prospective cohort longitudinal study was conducted over a 6-month period. Participants were assessed with a knowledge based questionnaire immediately prior to and after observing 12 fortnightly critical illness scenario demonstrations (CISDs). The outcome measure was performance on questionnaires. Regression analysis was used to adjust for potential confounders. Questionnaire practice effect was evaluated on 30 independent HCPs not exposed to the CISDs.Results: Fifty-four HCPs (40 doctors and 14 nurses) participated in the study. All participants had previously attended nationally accredited simulation courses with a mean time since last attendance of 1.8 ± 0.4 years. The median number of attendances at CISD was 6 (2–12). The mean questionnaire scores at baseline (17.2/25) were significantly lower than the mean post intervention questionnaire scores (20.3/25), p = 0.003. The HCPs self-rated confidence in managing CISD was 6.5 times higher at the end of the program in the intervention group (p = 0.002) than at baseline. There was no practice effect for questionnaires demonstrated in the independent sample.Conclusion: The educational intervention program significantly improved the knowledge and confidence of the participants in managing pediatric critical illnesses. The CISD program provides an inexpensive, practical, and time effective method of facilitating knowledge acquisition and retention. Despite the distinctively different approach, this study has shown the effectiveness of the participant being an observer to enhance pediatric resuscitation skills.

Round-the-table teaching: a novel approach to resuscitation education.

BackgroundEffective cardiopulmonary resuscitation saves lives. Health professionals who care for acutely unwell children need to be prepared to care for a child in arrest. Hospitals must ensure that their staff have the knowledge, confidence and ability to respond to a child in cardiac arrest. RESUS4KIDS is a programme designed to teach paediatric resuscitation to health care professionals who care for acutely unwell children. The programme is delivered in two components: an e–learning component for pre-learning, followed by a short, practical, face-to-face course that is taught using the round-the-table teaching approach.ContextRound-the-table teaching is a novel, evidence-based small group teaching approach designed to teach paediatric resuscitation skills and knowledge. Round-the-table teaching uses a structured approach to managing a collapsed child, and ensures that each participant has the opportunity to practise the essential resuscitation skills of airway manoeuvres, bag mask ventilation and cardiac compressions.InnovationRound-the-table teaching is an engaging, non-threatening approach to delivering interdisciplinary paediatric resuscitation education. The methodology ensures that all participants have the opportunity to practise each of the different essential skills associated with the Danger, Response, Send for help, Airway, Breathing, Circulation, Defibrillation or rhythm recognition (DRSABCD) approach to the collapsed child.ImplicationsRound-the-table teaching is based on evidence-based small group teaching methods. The methodology of round-the-table teaching can be applied to any topic where participants must demonstrate an understanding of a sequential approach to a clinical skill.Round-the-table teaching uses a structured approach to managing a collapsed child

Pediatric resident resuscitation skills improve after “Rapid Cycle Deliberate Practice” training

IntroductionPrevious studies reveal pediatric resident resuscitation skills are inadequate, with little improvement during residency. The Accreditation Council for Graduate Medical Education highlights the need for documenting incremental acquisition of skills, i.e. “Milestones”. We developed a simulation-based teaching approach “Rapid Cycle Deliberate Practice” (RCDP) focused on rapid acquisition of procedural and teamwork skills (i.e. “first-five minutes” (FFM) resuscitation skills). This novel method utilizes direct feedback and prioritizes opportunities for learners to “try again” over lengthy debriefing. ParticipantsPediatric residents from an academic medical center. MethodsProspective pre-post interventional study of residents managing a simulated cardiopulmonary arrest. Main outcome measures include: (1) interval between onset of pulseless ventricular tachycardia to initiation of compressions and (2) defibrillation. ResultsSeventy pediatric residents participated in the pre-intervention and fifty-one in the post-intervention period. Baseline characteristics were similar. The RCDP-FFM intervention was associated with a decrease in: no-flow fraction: [pre: 74% (5–100%) vs. post: 34% (26–53%); p<0.001)], no-blow fraction: [pre: 39% (22–64%) median (IQR) vs. post: 30% (22–41%); p=0.01], and pre-shock pause: [pre: 84s (26–162) vs. post: 8s (4–18); p<0.001]. Survival analysis revealed RCDP-FFM was associated with starting compressions within 1min of loss of pulse: [Adjusted Hazard Ratio (HR): 3.8 (95% CI: 2.0–7.2)] and defibrillating within 2min: [HR: 1.7 (95% CI: 1.03–2.65)]. Third year residents were significantly more likely than first years to defibrillate within 2min: [HR: 2.8 (95% CI: 1.5–5.1)]. ConclusionsImplementation of the RCDP-FFM was associated with improvement in performance of key measures of quality life support and progressive acquisition of resuscitation skills during pediatric residency.

Standardising paediatric resuscitation training in New South Wales, Australia: RESUS4KIDS

A key competency for all health-care workers (HCWs) who care for children is the ability to respond to a child in respiratory or cardiorespiratory arrest. However, evidence suggests that medical and nursing staff may not have the knowledge and clinical skills to respond to these emergencies. The aim of this project was to create a standardised, evidence-based, paediatric life support course that would be available free to all HCWs in New South Wales (NSW), including NSW Ambulance. A paediatric life support course was designed along current education principles. It used e-learning as pre-learning and a face-to-face short practical course, combining team work and communication with practical paediatric resuscitation skills training. The programme was designed to empower local trainers to deliver a standardised course to local participants. A total of 14,000 participants have completed the mandatory e-learning component, and over 8600 participants have completed the short practical course, across all NSW Local Health Districts, including NSW Ambulance. RESUS4KIDS has also been adopted by the universities of Sydney and Newcastle undergraduate medical and nursing programmes. Outside of NSW and ACT, over 400 participants have completed the course in facilities in Queensland, South Australia, Victoria and the Northern Territory. We have developed a course that is available, at no cost to individuals or facilities, to all HCWs in NSW, including students, paramedics and general practitioners. We would encourage all other jurisdictions to consider adopting the programme.

Board 106 - Program Innovations Abstract Development, Implementation and Evaluation of a Simulation Based Boot Camp for Fellows from Multiple Specialties - The Integrated Fellows Simulation Training Program (Submission #861)

Introduction/Background Simulation based boot camps have grown in popularity within teaching institutions over the last five years. The goals of these programs are to improve competence and clinical performance in new postgraduate medical trainees at the start of fellowship in an era of limited work hours and experience during residency training, increasing concerns for patient safety and the rapid growth of simulation programs within teaching institutions. Traditionally, these boot camps have been developed for a single discipline such as pediatric critical care, internal medicine or surgery.1-5 They can be limited to specialties with high volumes of trainees given the time, resources and expense of developing an intensive simulation training program. Additionally, at large institutions like ours, with over 23 fellowship programs, it can be a challenge to provide the space, equipment, and time needed to implement simulation based boot camps during the month of July when new trainees arrive. In order to meet this challenge, we found a need to provide simulation based boot camps applicable to multiple specialties for improved efficiency and education for all postgraduate pediatric trainees. Methods The objectives were to develop, implement, and evaluate the efficacy of a one day simulation based boot camp for pediatric, medical and surgical trainees from multiple specialties. An experienced group of simulation trained educators from three diverse specialties (Pediatric Emergency Medicine, Pediatric Critical Care Medicine and Neonatal Intensive Care Medicine) gathered to discuss goals and objectives for a simulation based boot camp for all pediatric medical and surgical trainees. A formal needs assessment was conducted via a survey with program directors from all pediatric subspecialties to identify educational gaps. Curricular objectives were made based on results of the survey and identification of common patient safety and educational goals for any pediatric medical and surgical trainee - basic pediatric resuscitation skills (airway management, CPR and defibrillation, code cart familiarity and emergency access), effective teamwork and communication including crisis resource management and difficult conversations (delivery of bad news and disclosure of medical errors). Detailed course documents were developed including didactics, skills station objectives, high fidelity manikin and standardized patient scenarios, performance checklists and scripted debriefs. Instructors, including both physicians, nursing and respiratory therapists, were trained in simulation based methodologies and regularly teach within our simulation program. In order to create true multi disciplinary training opportunities, new and experienced nurses, respiratory therapists and pharmacists were invited to participate as learners with the fellow trainees. The Integrated Fellows Simulation-based Training Course (IFST) has been implemented for the last three years during the month of July. Since then, postgraduate fellowship trainees from multiple subspecialties have attended including pediatric surgery, pediatric otolaryngology, pediatric neurosurgery, rheumatology, endocrinology, pediatric hospital medicine, pediatric critical care and pediatric emergency medicine. Average scores for course evaluations on a 5-point Likert scale (1 strongly disagree to 5 strongly agree) have shown a high degree of satisfaction. Average ratings for "I plan to apply what I learned here to my clinical practice", "I would recommend this course to my colleagues" and "I feel that this course has improved my ability to care for my patients" were 4.75, 4.66, and 4.66 respectively. Average scores for "I feel that this course has improved communication skills and patient safety" were 4.69 and 4.71. Conclusion A simulation based boot camp for a diverse group of postgraduate learners can be developed and implemented with a high level of learner satisfaction. Combined simulation based boot camps can effectively provide valuable education to trainees who might not otherwise have this opportunity, due to a lack of resources or sufficient numbers to implement specialty specific programs. Future evaluation will look at six month follow-ups on skill utilization and retention.

Anesthesiology Residents' Performance of Pediatric Resuscitation during a Simulated Hyperkalemic Cardiac Arrest

Anesthesiologists are responsible for the management of perioperative cardiopulmonary arrest in children. This study used simulation to assess the pediatric resuscitation skills of experienced anesthesia residents. Nineteen anesthesia residents were evaluated using a pediatric pulseless electrical activity scenario. The authors used a standardized checklist to evaluate the residents' diagnostic and therapeutic interventions. After the onset of pulseless electrical activity, 79% of residents initiated cardiopulmonary resuscitation within 1 min. Approximately one third (31%) performed chest compressions at the recommended rate. Epinephrine was administered by 95% of residents, but only one third used the correct pediatric dose. All residents administered fluid boluses, but only 16% administered the recommended volume. Only one fourth of the residents considered hyperkalemia as a cause of pulseless electrical activity. None of the residents asked for dosing aids. During this simulated pediatric emergency, anesthesia residents demonstrated an acceptable knowledge of general resuscitation maneuvers. However, a subset of resuscitation skills was incorrectly performed, mostly related to age or weight. Importantly, many residents did not consider the full differential diagnosis of pulseless electrical activity. Anesthesia residents may benefit from additional pediatric resuscitation training and practice using cognitive aids to access dosages and complicated diagnostic algorithms.

Using Screen‐Based Simulation to Improve Performance During Pediatric Resuscitation

To assess the ability of a screen-based simulation-training program to improve emergency medicine and pediatric resident performance in critical pediatric resuscitation knowledge, confidence, and skills. A pre-post, interventional design was used. Three measures of performance were created and assessed before and after intervention: a written pre-course knowledge examination, a self-efficacy confidence score, and a skills-based high-fidelity simulation code scenario. For the high-fidelity skills assessment, independent physician raters recorded and reviewed subject performance. The intervention consisted of eight screen-based pediatric resuscitation scenarios that subjects had 4 weeks to complete. Upon completion of the scenarios, all three measures were repeated. For the confidence assessment, summary pre- and post-test summary confidence scores were compared using a t-test, and for the skills assessment, pre-scores were compared with post-test measures for each individual using McNemar's chi-square test for paired samples. Twenty-six of 35 (71.3%) enrolled subjects completed the institutional review board-approved study. Increases were observed in written test scores, confidence, and some critical interventions in high-fidelity simulation. The mean improvement in cumulative confidence scores for all residents was 10.1 (SD +/-4.9; range 0-19; p < 0.001), with no resident feeling less confident after the intervention. Although overall performance in simulated codes did not change significantly, with average scores of 6.65 (+/-1.76) to 7.04 (+/-1.37) out of 9 possible points (p = 0.58), improvement was seen in the administering of appropriate amounts of IV fluids (59-89%, p = 0.03). In this study, improvements in resident knowledge, confidence, and performance of certain skills in simulated pediatric cardiac arrest scenarios suggest that screen-based simulations may be an effective way to enhance resuscitation skills of pediatric providers. These results should be confirmed using a randomized design with an appropriate control group.

The effect of the APLS-course on self-efficacy and its relationship to behavioural decisions in paediatric resuscitation

Aims Self-efficacy may predict performance following life-support training but may be negatively influenced by experiences during training. To investigate both this and the use of self-efficacy in self-assessment we investigated the relationship between self-efficacy and measured performance during a simulated resuscitation, and the effect of death of a simulated patient on self-efficacy. Materials and methods Consultant and trainee paediatricians and anaesthesiologists scored their self-efficacy for paediatric resuscitation skills before taking an unannounced simulated resuscitation test and objective structured clinical examination (OSCE)-tests of chest compressions and bag- and mask-ventilation. Performance in the simulation was scored by three independent expert observers and the OSCE's using a modified Berden and ventilation penalty scores. Results Self-efficacy for the relevant skill was significantly higher in doctors choosing to give chest compressions, to intubate or insert an intraosseous device and in those who decided to intubate early. Self-efficacy correlated moderately with the quality of global performance on the simulation but not with the OSCE scores, nor was quality of individual skills during the simulation related to self-efficacy. Self-efficacy was higher in doctors who had taken the Advanced Paediatric Life Support (APLS)-course. Death of the simulated patient had a negative effect on self-efficacy. Conclusion Self-efficacy seems to be predictive of certain actions during a simulated resuscitation but does not correlate with quality of performance of resuscitation skills. Self-efficacy might therefore be useful as a predictor of the application of learning, but cannot be recommended for self-assessment. There is evidence to support the unwritten rule during simulation training the patient should not be allowed to die.

Simulation-based Assessment of Paramedic Pediatric Resuscitation Skills

AbstrastBackground. Emergency medical services (EMS) providers infrequently encounter seriously ill and injured pediatric patients. Clinical simulations are useful for assessing skill level, especially for low-frequency, high-risk problems. Objective. To identify the most common performance deficiencies in paramedics' management of three simulated pediatric emergencies. Methods. Paramedics from five EMS agencies in Michigan were eligible subjects for this prospective, observational study. Three clinical assessment modules (CAMs) were designed and validated using pediatric simulators with varying technologic complexity. Scenarios included an infant cardiopulmonary arrest, sepsis/seizure, and child asthma/respiratory arrest. Each scenario required paramedics to perform an assessment and provide appropriate pediatric patient care within a 12-minute time limit. Trained instructors conducted the simulations by following strict guidelines for sequences of events and responses. Videos of CAMs were reviewed by an independent evaluator to verify scoring accuracy. Percentage of steps completed for each of the three scenarios and specific performance deficiencies were recorded. Results. Two hundred twelve paramedics completed the CAMs. The average percentages of steps completed were as follows: arrest CAM, 45.3%; asthma CAM, 51.6%; and sepsis CAM, 47.1%. Performance deficiencies included lack of airway support or protection; lack of support of ventilations or cardiac function; inappropriate use of length-based treatment tapes; and inaccurate calculation and administration of medications and fluids. Conclusion. Multiple deficiencies in paramedics' performance of pediatric resuscitation skills were objectively identified using three manikin-based simulations. EMS educators and EMS medical directors should target these specific skill deficiencies when developing continuing education in prehospital pediatric patient care.

Teaching paediatric resuscitation skills in a developing country: Introduction of the Advanced Paediatric Life Support course into Vietnam

In 2001, a nationwide study revealed deficiencies in the emergency care of seriously ill and injured children in Vietnam. In response, a project was initiated to conduct the Advanced Paediatric Life Support course in Vietnam and ascertain whether this course would provide a practical and sustainable method of improving the knowledge and skills of medical and nursing staff in this area. After approval to use the course was secured and funding obtained, the project commenced in 2003. Key Vietnamese personnel travelled to Australia to complete the course, undertake instructor training and gain organizational experience. Teaching materials were translated, reviewed and modified to account for local diseases and clinical practices while maintaining the fundamental principles of the parent course. Commencing in March 2004, 10 courses were conducted by Australian and Vietnamese instructors, training 239 doctors and nurses from a wide variety of clinical backgrounds. Additionally, three instructor courses were conducted, training 52 new instructors. As the skill and confidence of the Vietnamese instructors grew, the number and responsibilities of the international faculty reduced. The infrastructure now exists for the course to operate in a sustainable fashion within Vietnam. We believe that this project demonstrates that the course can be successfully modified to provide teaching in paediatric emergency care in a developing country.

Pediatric Resuscitation Mock Code Practice Impacts Selected Skills

Objectives: Determine the utility of a computer‐controlled mannequin in training and assessment of resident pediatric resuscitation skills. Determine if mock code practice is beneficial in maintaining mastery of critical pediatric resuscitation skills.Methods: A prospective randomized study of 22 interns (12 pediatric, 10 emergency medicine) randomized to: Group 1 (cases who participated in 3 mock codes over a 6 month period) and Group 2 (controls who did not receive mock code practice). Each intern was randomly paired in teams of two who participated at baseline in two code scenarios using the Laerdal Simbaby. The interns alternated airway and circulatory management responsibility. At 6 months all interns returned to the simulator in pairs to participate in another two pediatric code scenarios. All sessions were videotaped and time of computer initiation of scenario events recorded. Videos were examined by a pediatric emergency physician (blinded to Group participation) using a structured recording form. A general linear model was used to assess differences in response times and Fisher's exact tests for categorical data.Results: Whether in charge of airway or circulatory management, at post test interns who had completed mock codes required less time to: recognize the need for bag mask ventilation (Diff 5.6 seconds, p &lt; 0.005), initiate BVM (Diff 2.7 seconds, p &lt; 0.006), intubate (Diff 22 seconds, p &lt; 0.03), and recognizing the need for chest compressions (Diff 24 seconds, p &lt; 0.03). There were no differences in times for recognizing the need for fluid resuscitation or for factors such as appropriate mask size, rate of ventilation, intubation success (including number of attempts), compression techniques, or IO placement.Conclusions: Computer controlled mannequins provide reproducible measurable experiences. This study demonstrates that mock code practice may impact some, but not all, aspects of pediatric resuscitation skill retention.

Simulation-based Assessment of Paramedic Pediatric Resuscitation Skills

Simulation-based Assessment of Paramedic Pediatric Resuscitation Skills