title: Simulation training based on observation with minimal participation improves paediatric emergency medicine knowledge, skills and confidence.
abstract: OBJECTIVE
  Simulation is becoming standard during emergency medicine (EM) training. To determine if observation-based simulation with minimal participation improves knowledge, skill performance and confidence, we created and evaluated 12 paediatric emergency medicine (PEM) simulations focusing on the educational value of observation.
  
  
  METHODS
  Thirty-one EM residents participated in 1-2 simulations each and observed multiple others. Scores obtained on a knowledge test presimulation and postsimulation, clinical skills assessed for changes in performance over the course of the study, and confidence questionnaires given presimulation and postsimulation were analysed. Participants' feedback regarding the observation model was also evaluated.
  
  
  RESULTS
  Average scores obtained on the knowledge test improved significantly presimulation to postsimulation (36.3% vs 51.4%), and remained consistent postsimulation to 4 months after simulation training (51.4% vs 48.8%). Gain scores for participants who observed >80% of the simulations were significantly higher than for those who observed<80% (20.7% vs 12.5%). Over 90% of skillsets reassessed throughout the simulations showed improvement, and residents assessed themselves as more confident after simulation training. All participants rated the training as very useful, and 71% reported that being observed was stressful but beneficial, as clinical emergencies are stressful as well.
  
  
  CONCLUSIONS
  Using observation with minimal participation as the foundation of simulation training may lead to improvement in observer knowledge, skills and confidence. Observation-based simulation training may also save time and resources, allowing a broader coverage of clinical scenarios than programmes requiring active participation by all learners.
authors.affiliation: Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia, USA Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Bloch
authors.affiliation: Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia, USA Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina, USA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Bloch
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D019370:Observation; D016544:Patient Simulation; D010372:Pediatrics / Q000193:education*; D020377:Self Efficacy; D000066908:Simulation Training / Q000379:methods*
keywords: education, methods; education, teaching; paediatric emergency med; paediatrics; teaching