The Impact of a Multifaceted Simulation Education and Feedback Program for Community Emergency Departments on Pediatric Diabetic Ketoacidosis Management.

OBJECTIVES: We sought to determine if general emergency departments (GEDs) were managing pediatric diabetic ketoacidosis (DKA) correctly and if management could be improved using a multilayered educational initiative. We hypothesized that a multifaceted program of in situ simulation education and formal feedback on actual patient management would improve community GED management of pediatric DKA. METHODS: This study combined a prospective simulation-based performance evaluation and a retrospective chart review. A community outreach simulation education initiative was developed followed by a formal patient feedback process. RESULTS: Fifteen hospitals participated in simulation sessions and the feedback process. All hospitals were scored for readiness to provide care for critically ill pediatric patients using the Emergency Medical Services for Children (EMSC) Pediatric Readiness Assessment. Six of the 15 have had a second hospital visit that included a DKA scenario with an average performance score of 60.3%. A total of 158 pediatric patients with DKA were included in the chart review. The GEDs with higher patient volumes provided best practice DKA management more often (63%) than those with lower patient volumes (40%). Participating in a DKA simulated scenario showed a trend toward improved care, with 47.2% before participation and 68.2% after participation ( P = 0.091). Participating in the formal feedback process improved best practice management provided to 68.6%. Best practice management was further improved to 70.3% if the GED participated in both a DKA simulation and the feedback process ( P = 0.04). CONCLUSIONS: A multifaceted program of in situ simulation education and formal feedback on patient management can improve community GED management of pediatric patients with DKA.

Suicide Simulation in Primary Care.

OBJECTIVES: This project was developed because residents need to gain knowledge and experience in promptly recognizing patients with suicidal ideation. Our study allowed pediatric interns the opportunity to manage a simulated 16-year-old actively suicidal patient in the resident continuity clinic for a well-child visit. METHODS: During their first year, each resident receives simulation training. The simulation scenario for this study involves the use of a standardized patient (SP). Sessions take place in the pediatric simulation center and are recorded for observation and review. The scenario was scripted and piloted to ensure standardization in educational intervention. Postscenario, participants have a nonjudgmental debriefing with the attending physician and the SP. An anonymous survey is completed after training. Enrollment was June 2016-September 2019, with two to three 1-hour cases monthly. RESULTS: Seventy-one postgraduate year-1 residents participated. Sixty-one residents left the suicidal patient alone/unobserved. Fifteen participants never learned of the intent of suicide during their initial intake with the patient but believed that she was depressed. The mean time to ask about suicidal ideation, when applicable, was 8:32 minutes (standard deviation 4:10 minutes, range 2:15-24:48 minutes). Common learning themes included realistic exposure to an actively suicidal patient and simulation debriefing/direct feedback from the SP. CONCLUSIONS: Practicing this crucial but somewhat rare primary care mental health emergency for all interns was possible when structured monthly. Feedback was extremely positive, with learners' feeling more prepared postsimulation. Our simulation experience also allows supervisors to assess intern's individual abilities to communicate in a difficult patient scenario which is an important physician competency as defined by the Accreditation Council for Graduate Medical Education.

Travel Histories in Children: How Well Do Interns and Medical Students Do?

OBJECTIVE: To evaluate the knowledge of obtaining travel histories in medical students and interns. METHODS: Medical students and interns participated in a high-fidelity pediatric simulation with two cases (malaria or typhoid fever) that hinged on travel history. After the simulation, appropriate methods of obtaining travel histories were discussed. Participants completed surveys regarding their previous education and comfort with obtaining travel histories. If and how a travel history was obtained was derived from simulation observation. RESULTS: From June 2016 to July 2017, 145 medical trainees participated in 24 simulation sessions; 45% reported no prior training in obtaining travel histories. Participants asked for a travel history in all but 2 simulations; however, in 9 of 24 simulations (38%), they required prompting by either a simulation confederate or laboratory results. Participants were more comfortable diagnosing/treating conditions acquired from US domestic travel than from international travel (32.9% vs 22.4%, P < 0.001). Previous education in obtaining travel histories and past international travel did not significantly influence the level of comfort that participants felt with travel histories. CONCLUSIONS: This study highlights the lack of knowledge regarding the importance of travel histories as part of basic history taking. Medical students and interns had low levels of comfort in obtaining adequate travel histories and diagnosing conditions acquired from international travel.

A Simulation Course Focusing on Forensic Evidence Collection Improves Pediatric Knowledge and Standardizes Curriculum for Child Abuse.

OBJECTIVES: Our hypothesis was that pediatric residents and medical students who participated in a structured forensic evidence collection course would have improved knowledge of prepubertal evidence collection practices and pubertal genital anatomy. METHODS: The course curriculum included a forensic evidence collection video created by the sexual assault nurse examiner directors. After watching the video, the participants simulated forensic evidence collection using forensic evidence collection kits and chain of evidence protocols in a hybrid simulation setting under the supervision of a pediatric sexual assault nurse examiner. The participants completed a multiple-choice test and a fill-in-the-blank anatomical diagram test before and after the course. RESULTS: Of an eligible 48 participants, 42 completed the course; therefore, our participant response rate was 87.5%. There was significant improvement in knowledge, with an average pretest score of 62% ± 20% and the average posttest score of 86% ± 9% (P < 0.001). Qualitative evaluations were overwhelmingly positive, with consistent scoring of 6/6 in a 6-point agree scale. Learning themes, which emerged from open-ended questions on the evaluations, included knowledge gained on evidence collection processes (n = 26), how to appropriately interact with abused patients (n = 8), hands-on nature of the experience and the benefits of walking through the examination (n = 7), and pubertal genital anatomy knowledge (n = 3). Participants suggested that more instruction on anatomy would be helpful. CONCLUSIONS: We found that pediatric residents' and medical students' knowledge of pediatric sexual abuse may be improved with a short simulation course focusing on forensic evidence collection.

Observational Study on the Effect of Duration from Pediatric Advanced Life Support (PALS) Certification on PALS Performance in Pediatric Interns in Simulated Cardiopulmonary Arrest.

Pediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days-3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups ( p = 0.036). Time to defibrillation was longer in the 3 days group than the other groups ( p = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.

Professional Success: Utilizing Simulation to Remediate and Retain Nursing Staff.

Nursing education focuses on nursing theory and the ability to perform tasks. There is a lack of education related to prioritization of nursing tasks. Therefore, new nurses transitioning into their roles sometimes struggle and, as a result, leave their units or, often enough, our facility. We developed a Professional Success Program that includes cognitive prioritization exercises and simulation scenarios to assist these nurses. After utilizing the program, our facility has seen an increase in nurse retention.

The Impact of a 9-Month Booster Training Using Rapid Cycle Deliberate Practice on Pediatric Resident PALS Skills.

INTRODUCTION: The impact of booster training on pediatric resuscitation skills is not well understood. Rapid cycle deliberate practice (RCDP) to supplement pediatric advanced life support (PALS) training is beginning to be used to improve resuscitation skills. We tested the impact of booster RCDP training performed at 9 months after initial RCDP training on pediatric resuscitation skills of pediatric residents. OBJECTIVE: This study evaluated the impact of a 9-month RCDP booster training on PALS skills compared with usual practice debriefing (plus/delta) after an initial RCDP training session for PALS-certified pediatric interns. METHODS: All pediatric interns at a single institution were invited to a 45-minute RCDP training session after their initial PALS certification. The PALS performance score and times for key events were recorded for participants immediately before and after the RCDP training as well as 6, 9, and 12 months after the RCDP training. Learners were randomized to an RCDP intervention and usual practice (plus/delta) group. The intervention group received booster RCDP training after their 9-month assessment. RESULTS: Twenty eight of 30 residents participated in the initial training with 22 completing randomization at 9 months. There was no significant difference in 12-month PALS median performance scores after the booster training between the intervention and usual practice groups (83% vs. 94%, P = 0.31). There was significant improvement in PALS performance score from 51 ± 27% pre-initial RCDP assessment to 93 ± 5% post-initial RCDP training (P < 0.001). There were significant improvements in individual skills from pre- to post-initial RCDP testing, including time to verbalize pulseless, start compressions, and attach defibrillation pads (P < 0.001). CONCLUSIONS: Rapid cycle deliberate practice booster training versus plus/delta training at 9-month post-initial RCDP training did not alter 12-month performance. However, RCDP is effective at improving PALS performance skills, and this effect is maintained at 6, 9, and 12 months. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.