title: On Shaky Ground: Learner Response and Confidence After Tabletop Earthquake Simulation.
abstract: OBJECTIVE
  The aim of this study was to evaluate residents' confidence and attitudes related to management of earthquake victims during a tabletop simulation and 6 months after the intervention.
  
  
  METHODS
  Pediatric residents from 4 training programs were recruited via e-mail. The tabletop simulation involved 3 pediatric patients (crush injury, head injury, and a nonverbal patient with minor injuries). A facilitated debriefing took place after the simulation. The same simulation was repeated 6 months later. A survey was administered before the simulation, immediately after, and after the 6-month repeat simulation to determine participants' self-rated confidence and willingness to respond in the event of a disaster. A 5-point Likert scale that ranged through novice, advanced beginner, competent, proficient, and expert was used.
  
  
  RESULTS
  Ninety-nine participants completed the survey before the initial simulation session. Fifty-one residents completed the immediate postsurvey, and 75 completed the 6-month postsurvey. There was a statistically significant improvement in self-rated confidence identifying and managing victims of earthquake disasters after participating in the simulation, with 3% rating themselves as competent on the presurvey and 33% rating themselves as competent on the postsurvey (P < 0.05). There was a nonstatistically significant improvement in confidence treating suspected traumatic head injury as well as willingness to deploy to both domestic and international disasters.
  
  
  CONCLUSIONS
  Tabletop simulation can improve resident comfort level with rare events, such as caring for children in the aftermath of an earthquake. Tabletop can also be easily integrated into resident curriculum and may be an effective way to provide disaster medical response training for trainees.
authors.affiliation: From the *Section of Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT; †Children's Hospital Los Angeles, Los Angeles, CA; ‡Division of Pediatric Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA; §Department of Pediatrics, Medical University of South Carolina, Charleston, SC; and ∥Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Whitney
authors.forename: Rita V
authors.initials: RV
authors.lastname: Burke
authors.forename: Kathy
authors.initials: K
authors.lastname: Lehman-Huskamp
authors.forename: Gitanjli
authors.initials: G
authors.lastname: Arora
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Park
authors.forename: Mark X
authors.initials: MX
authors.lastname: Cicero
mesh_terms: D002983:Clinical Competence; D004189:Disaster Planning / Q000458:organization & administration*; D055866:Earthquakes; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000193:education; D000066908:Simulation Training / Q000379:methods*; D011795:Surveys and Questionnaires