title: Repeated versus varied case selection in pediatric resident simulation.
abstract: BACKGROUND
  Repeated exposure to pediatric emergency scenarios improves technical skills, but it is unclear whether repeated exposure to specific cases affects medical decision making in varied cases.
  
  
  OBJECTIVE
  We sought to determine whether repeated exposure to 1 scenario would translate to improved performance and decision making in varied scenarios.
  
  
  METHODS
  Senior pediatrics residents participated in 3 scenarios with scripted debriefing. Residents were randomized to repeated practice (RP) scenarios or mixed (MIX) scenarios. RP residents completed pulseless electrical activity (PEA) with different stems (Case 1, 2, 3). MIX residents completed PEA (Case 1), seizure (Case 2), and ventricular tachycardia (Case 3) scenarios. Four months later, participants returned to complete 3 more cases: PEA (Case 4), seizure (Case 5), and critical coarctation (Case 6).
  
  
  RESULTS
  Twenty-three residents participated in the study and were randomized to either the RP or the MIX group. The RP group showed statistically significant improvement in time to start chest compressions, whereas the MIX group showed no improvement. Use of a backboard improved significantly in Case 4 for the RP group but not for the MIX group. Similarly, time to check glucose in the seizure scenario was significantly better in the MIX group that had previous exposure to a seizure scenario. No differences in performance were noted between groups in Case 6, which was new to both groups.
  
  
  CONCLUSIONS
  Results of this study indicate that whereas repeated exposure may improve decision-making skills in similar scenarios, it may not translate to improved medical decision making in other scenarios.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Tofil
authors.forename: Dawn Taylor
authors.initials: DT
authors.lastname: Peterson
authors.forename: Julie Turner
authors.initials: JT
authors.lastname: Wheeler
authors.forename: Amber
authors.initials: A
authors.lastname: Youngblood
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Zinkan
authors.forename: Diego
authors.initials: D
authors.lastname: Lara
authors.forename: Brett
authors.initials: B
authors.lastname: Jakaitis
authors.forename: Julia
authors.initials: J
authors.lastname: Niebauer
authors.forename: Marjorie Lee
authors.initials: ML
authors.lastname: White