We are looking at the feasibility of redesigning the existing simulation education for first-year residents within the Children’s Hospital of Richmond at VCU’s pediatric residency program to increase learning opportunities and to enhance exposure to pediatric medical emergencies. Novel simulation scenarios were designed to provide an introduction to managing the first five minutes of commonly encountered emergencies on the inpatient wards. These shortened simulations allow for educational objectives to be tailored to the expected knowledge and responsibilities of first-year residents

Coe, Megan E.

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VCU Scholars Compass

Virginia Commonwealth UniversityVCU Scholars CompassMedical Education Symposium School of Medicine2017The First Five Minutes: Enhancing SimulationEducation for First-Year Pediatric ResidentsMegan E. CoeVCUFollow this and additional works at: https://scholarscompass.vcu.edu/med_eduPart of the Medicine and Health Sciences Commons© The Author(s)This Poster is brought to you for free and open access by the School of Medicine at VCU Scholars Compass. It has been accepted for inclusion inMedical Education Symposium by an authorized administrator of VCU Scholars Compass. For more information, please contact libcompass@vcu.edu.Downloaded fromhttps://scholarscompass.vcu.edu/med_edu/23BackgroundSimulation is an underutilized resource in medical education within theChildren’s Hospital of Richmond (CHoR) at Virginia CommonwealthUniversity's (VCU) pediatric residency program. Pediatric resuscitation eventsare rare. Of those pediatric patients manifesting duress, respiratory distress,shock, and impending cardiopulmonary arrest are common presentations.1-2Adding to the limited exposure of pediatric trainees to such events is therestriction on duty hours, the changing patterns of health care delivery andpatient safety, as well as the ever-growing number of medical trainees.3-4A survey conducted in June 2016 of PGY-1 residents at this program at the endof their first year in residency showed that of 18 respondents, 10 (55%) hadnot participated in a rapid response or code on the inpatient floor in theprevious 11 months. While all had participated in at least one mock code in thesimulation center, only 11 (61%) were able to be the designated team leader ina resuscitation scenario. This pattern has been shown elsewhere to persistoutside of simulation education, with at least one survey showing only a smallpercentage of senior pediatric residents ever having led a resuscitation event inreal-time.5 Furthermore, while all pediatric trainees at CHoR/VCU obtain PALScertification, studies have shown that retention of essential knowledge andskills obtained in these sessions deteriorates over time, indicating the need forfrequent repetition.6While there exists many examples of simulation education within pediatricresidency programs, there is wide variability in content, audience, assessmentmethods, and sustainability models.7-9 Few have attempted to create astandardized curriculum for implementation across different pediatricresidency programs.10 Based off proven need and off of existing examples, wehave attempted to create a feasible simulation curriculum for our first-yearpediatric residents aimed at providing instruction in effectively managing thefirst-five minutes of commonly encountered pediatric emergency scenarios.DiscussionEach categorical pediatric PGY-1 resident was scheduled into two separatesimulation sessions this year, achieving our main objective of increasing simulationexposure for first-year pediatric residents. Each resident’s individual session wasseparated by at least two months, with most resident’s first session occurring in thefirst half of the year and second session in the second half of the year. First-yearmedicine/pediatric residents were unable to be scheduled into any session giventheir increased schedule restrictions.The first obstacle to implementing this new curriculum was writing novelsimulation scenarios to capture the events that typically occur in the first fiveminutes of common pediatric emergency scenarios. The scenarios went throughseveral revisions and test-runs before being implemented with our intendedlearners throughout the year. We easily complete up to five scenarios in a 3 hoursession, leaving ample time for discussion and debriefing. The shorter 5-minutescenarios have been well-received and have frequently been reported as “realistic”and “reflective” of what is seen on the inpatient wards. Much of learner feedbackoccurs in real-time during debriefing, but also through an evaluation formcompleted at the end of each session. Further assessment of learner attitudesrequires completion of an end-of-year survey.Evaluating learner progression throughout the course of the simulation curriculumis challenging. Direct observation by instructors as learners navigate the scenariosis one means; however, this is subjective and comparisons over time are difficult.We attempted to measure completion rate of critical tasks as well as measure thetime elapsed until accurate implementation of these tasks. This data was collectedthrough video review of the recorded simulation sessions. Differences in the orderof seconds within a five minute scenario may prove insignificant to measure learneracquisition of knowledge or skills. In terms of teamwork and communication, weare using the Mayo teamwork assessment scale and will be eager to gauge learnerperception of these important objectives at the completion of this year.Moving forward, we would like to expand simulation education to PGY-2 and 3levels, creating scenarios tailored to the increased responsibilities of a seniorresident. We would like to continue our focus on teamwork and communication andwill be looking to use validated assessment methods and will inquire whether theseassessments can accurately reflect quality in simulation education.The first five minutes: enhancing simulation education for first-year pediatric residentsMethods and Materials• Pre-simulation survey gauging attitudes• 3-5 first year residents per session• 9 sessions throughout PGY-1 yearDay of:• Pre-briefing session• 5-10 minute emergency scenarios• Bronchiolitis• Septic shock• Supraventricular tachycardia• Seizure• Anaphylaxis• Debriefing • Advocacy/inquiry method• GTSC• Mayo High Performance Teamwork ScaleResultsA 12 question survey was sent out to each categorical and medicine/pediatric first-year resident to gauge attitudes towards resuscitation events andtowards simulation education. We had 100% response rate. Each question utilized a 5-point Likert scale. Overall, the responses indicate a lack of comfortand preparedness for handling resuscitation events and indicated positive attitudes towards simulation education.Objectives• Increase the amount of simulation education experience• Each learner would function as team leader twice per year• Focus on the first five minutes of a resuscitation event• Improve team communication skills during stressful events• Evaluate how learners progress over the course of the year• Gauge attitudes towards simulation education• Gauge attitudes towards resuscitation skillsMegan E Coe, MD, David E Marcello III, MD, FAAP, and Cheryl N Bodamer PhD, MPH, RN, CHSEStrongly Agree50%Agree50%Lack of experience running an RRT or code is a barrier to my performance in an emergency resuscitation eventStrongly Disagree10%Disagree70%Neutral15%Agree5%Strongly Agree0%I understand what various resources are available during a code event and can effectively utilize themStrongly Disagree20%Disagree55%Neutral10%Agree10%Strongly Agree5%I am eager and willing to be the first person to arrive bedside during an RRT or codeStrongly Disagree10%Disagree45%Neutral40%Agree5%Strongly Agree0%I can effectively organize a team and manage and distribute tasks during a resuscitation eventReferences1. Goldman RD, Ho K, Peterson R, Kissoon N. Bridging the knowledge-resuscitation gap for children: Still a long wayto go. Paediatric Child Health. 2007;12(6):485-4892. Schoenfeld PS, Baker MD. Management of cardiopulmonary and trauma resuscitation in the pediatric emergencydepartment. Pediatrics. 1993;91(4):726-7293. Mills DM, Williams DC, Dobson JV. Simulation training as a mechanism for procedural and resuscitation educationfor pediatric residents: a systematic review. Hospital Pediatrics. 2013;3(2):167-1764. Ojha R, Liu A, Rai D, Nanan R. Review of simulation in pediatrics: the evolution of a revolution. Front Pediatr.2015;3(106)5. Hunt EA, Patel S, Ver K, Shaffner DH, Pronovost PJ. Survey of pediatric resident experiences with resuscitationtraining and attendance at actual cardiopulmonary arrests. Pediatr Crit Care Med. 2009;10(1):96-1056. White JRM, Shugerman R, Brownlee C, et al. Performance of advanced resuscitation skills by pediatric housestaff.Arch Pediatr Adolesc Med. 1998;152(12):1232-12357. Sam J, Pierse M, Al-Qahtani A, Cheng A. Implementation and evaluation of a simulation curriculum for paediatricresidency programs including just-in time in-situ mock codes. Paediatric Child Health. 2012;17(2):e16-e208. Couloures KG, Allen C. Use of simulation to improve cardiopulmonary resuscitation performance and code teamcommunication for pediatric residents.MedEdPORTAL Publications. 2017;13:105559. Tofil NM, White ML, Manzella B, McGill D, Zinkan L. Initiation of a pediatric mock code program at a children’shospital.Med Teach 2009;31:e241-24710. Stone K, Reid J, Caglar D, Christensen A, Strelitz B, Zhou L, Quan L. Increasing pediatric resident simulatedresuscitation performance: a standardized simulation-based curriculum. Resuscitation. 2014;85(8):1099-1105

The First Five Minutes: Enhancing Simulation Education for First-Year Pediatric Residents

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The First Five Minutes: Enhancing Simulation Education for First-Year Pediatric Residents

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