Evaluating simulation education via electronic surveys immediately following live critical events: a pilot study.

BACKGROUND AND OBJECTIVES: Simulation-based medical education has become popular in postgraduate training for medical emergencies; however, the direct impact on learners' clinical performances during live critical events is unknown. Our goal was to evaluate the perceived impact of simulation-based education on pediatric emergencies by auditing pediatric residents immediately after involvement in actual emergency clinical events. METHODS: Weekly team-based pediatric simulation training for inpatient emergencies was implemented in an academic tertiary care hospital. Immediately after actual pediatric emergency events, each resident involved was audited regarding roles, performed tasks, and perceived effectiveness of earlier simulation-based education. The audit was performed by using a Likert scale. RESULTS: From September 2010 through August 2011, a total of 49 simulation sessions were held. During the same period, 27 pediatric emergency events occurred: 3 code events, 14 rapid response team activations, and 10 emergency transfers to the PICU. Forty-seven survey responses from 20 pediatric residents were obtained after the emergency clinical events. Fifty-three percent of residents felt well prepared, and 45% reported having experienced a similar simulation before the clinical event. A preceding similar simulation experience was perceived as helpful in improving clinical performance. Residents' confidence levels, however, did not differ significantly between those who reported having had a preceding similar simulation and those who had not (median of 4 vs median of 3; P=.16, Wilcoxon rank-sum test). CONCLUSIONS: A novel electronic survey was successfully piloted to measure residents' perceptions of simulation education compared with live critical events. Residents perceived that their experiences in earlier similar simulations positively affected their performances during emergencies.

How to use: transcutaneous bilirubinometry.

The National Institute for Health and Clinical Excellence neonatal jaundice guidelines recommend checking the bilirubin level in all infants with visible jaundice. The gold standard for this measurement is total serum bilirubin (TSB). Transcutaneous bilirubinometry (TcB) is an alternative to TSB that has been validated for clinical use through extensive study. TcB provides many advantages over TSB including instantaneous measurements without requiring a painful lab draw. For infants >35 weeks gestation, TcB can reliably identify infants at risk for severe hyperbilirubinaemia and can decrease the number of TSB measurements obtained. However, paediatric providers should be aware of limitations in clinical use of TcB including decreasing accuracy at higher bilirubin levels, lack of independently validated nomograms for interpretation and limited research regarding its use during phototherapy.