Using screen-based simulation to improve performance during pediatric resuscitation.
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.
Biese
Kevin J
KJ
Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kbiese@med.unc.edu
Moro-Sutherland
Donna
D
Furberg
Robert D
RD
Downing
Brian
B
Glickman
Larry
L
Murphy
Alison
A
Jackson
Cheryl L
CL
Snyder
Graham
G
Hobgood
Cherri
C
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*