Utilizing High-fidelity Simulators in Improving Trainee Confidence and Competency in Code Management.

Simulation training is central in preparing practitioners for code management that is free from patient harm.1 The purpose of this study was to determine if using a high-fidelity simulator in pediatric code education would improve trainee confidence and competency compared with the use of a traditional mannequin in the same setting. METHODS: Fifty-third-year medical students participated in Pediatric Advanced Life Support code training, including a mock code scenario. Students were randomized into two groups and assigned to a simulator group: high-fidelity simulator (Group 1) or traditional mannequin (Group 2). To assess competency, trainees were evaluated using a checklist of required verbalized items or performed during the mock code scenario. To assess confidence, trainees completed pre- and postintervention confidence surveys, which were collected and compared. RESULTS: Both Group 1 and Group 2 reported increased overall confidence in code management upon completion of their training. Although confidence increased universally, Group 1 reported increased confidence over that of Group 2 in three specific areas: ability to treat respiratory arrest, ability to run a code, and knowledge of the Pediatric Advanced Life Support algorithm. Group 1 also demonstrated increased competency in code management compared with Group 2 in four key code components: checking airway, checking breathing, checking pulses, and checking capillary refill. CONCLUSIONS: Trainee confidence increases after completion of Pediatric Advanced Life Support code training, regardless of simulator type utilized. However, trainees were more competent in code management when trained using a high-fidelity simulator compared with a traditional mannequin.

Evaluating the use of high-fidelity simulators during mock neonatal resuscitation scenarios in trying to improve confidence in residents.

OBJECTIVE: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents. METHODS: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys. RESULTS: Statistically significant (p < 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter. CONCLUSION: These results revealed that high-fidelity simulation-based training has significant positive gains in residents' self-reported confidence.

The Use of Telehealth to Teach Reproductive Health to Female Rural High School Students.

STUDY OBJECTIVE: To evaluate the use of telehealth to teach reproductive health to rural areas with high rates of teen pregnancy. DESIGN: Prospective cohort study. SETTING: Two high schools in rural West Virginia. PARTICIPANTS: High school female students who attended telehealth sessions. INTERVENTIONS: Teleconferencing equipment connected rural high schools to a distal academic institution. Telehealth sessions included reproductive health and life skills topics. Demographic information, session pre- and post-tests, and 6- month assessment was obtained. MAIN OUTCOME MEASURES: Reproductive health knowledge, behavior, and self-efficacy were assessed at intervention and at 6 months, along with Likert scale evaluation of telehealth as an educational tool. RESULTS: Fifty-five students participated in the program with an average age of 16.14 (SD 1.24) years. Only 20% (10/50) of subjects' mothers and 12% (6/50) of subjects' fathers had achieved education beyond high school, and 20% (10/50) of subject's mothers had experienced teen pregnancies (age 18 or younger). Sexual activity was reported among 52% (26/50) of subjects, 4/50 (8%) reported desire to become pregnant within the next year, and 4/50 (8%) reported already pregnant. Thirty-seven students completed the 6-month follow-up survey. Reported condom use increased from 20% (10/50) at baseline to 40% (15/37) at 6 months (P = .04) and hormonal contraception use increased from 22% (11/50) to 38% (14/37) (P = .12). Report of human papillomavirus vaccination increased from 38% (10/26) to 70% (26/37) (P = .001) among all subjects. At 6 months, 91.8% (34/37) reported the use of telehealth was "very effective" as a means to teach the material. CONCLUSIONS: Telehealth is an effective tool to teach reproductive health to rural areas.

A Quality Improvement Project to Improve Family Recognition of Medical Team Member Roles.

OBJECTIVE: Previous studies have shown that inpatients and families in academic settings have a limited ability to recall either their medical team members or the roles of those members. This is an important issue for patient and family satisfaction as well as patient safety. The objective of this study was to increase families' recognition of medical team members' roles. METHODS: We established a multidisciplinary quality improvement leadership team, measured family recognition of medical team members and their roles, and conducted 2 PDSA (Plan-Do-Study-Act) cycles. The first intervention was standardization of the content and delivery of our verbal team introductions to ensure inclusion of essential elements and family engagement. The second intervention was addition of an informational white board in each patient room. The prospective study included 105 families in the preintervention phase, 103 post-PDSA cycle 1, and 92 post-PDSA cycle 2. RESULTS: After conduction of 2 PDSA cycles, the recognition of the attending role increased from 49% to 87% (P = .000), the resident role from 39% to 73% (P = .000), and the medical student from 75% to 89% (P = .038). CONCLUSIONS: The multidisciplinary quality improvement model was effective in improving family recognition of the roles of attending physicians, resident physicians, and medical students. Consistent attention to engaging the families and explaining our roles as well as providing informational white boards are effective interventions to facilitate this process.