title: Using screen-based simulation to improve performance during pediatric resuscitation.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kbiese@med.unc.edu
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Biese
authors.forename: Donna
authors.initials: D
authors.lastname: Moro-Sutherland
authors.forename: Robert D
authors.initials: RD
authors.lastname: Furberg
authors.forename: Brian
authors.initials: B
authors.lastname: Downing
authors.forename: Larry
authors.initials: L
authors.lastname: Glickman
authors.forename: Alison
authors.initials: A
authors.lastname: Murphy
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Jackson
authors.forename: Graham
authors.initials: G
authors.lastname: Snyder
authors.forename: Cherri
authors.initials: C
authors.lastname: Hobgood
mesh_terms: D022561:Advanced Cardiac Life Support / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D004635:Emergency Medicine / Q000193:education*; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007396:Internship and Residency; D010370:Pediatric Assistants; D010372:Pediatrics / Q000193:education*; D013663:Teaching / Q000379:methods*