560 - Utilizing Simulation to Develop Novel Curriculum on Management of Tracheostomy Emergencies

The number of technology-dependent children, such as those with tracheostomies and ventilator dependence, has increased. These patients may intimidate residents, emergency physicians and primary care providers who have little knowledge or experience and confidence in managing common tracheostomy related complications. This underscores the need for training that enables residents to quickly recognize and manage complications. Published curricula and related studies including simulation are scarce and previous studies have not assessed retention of knowledge. We aimed to bridge this knowledge gap with curriculum utilizing simulation to offer a framework to educate, assess, and debrief learners caring for the child with tracheostomy and ventilator requirements.

Objective:

Learners will demonstrate improved self-efficacy, technical skills, and knowledge retention following a curriculum concerning tracheostomy complications via asynchronous learning and simulation-based skills training.

Design/Methods:

This is a non-randomized pre/post study requiring descriptive analyses. Simulation was used to improve self-efficacy and retention of critical skills and knowledge related to managing tracheostomy emergencies. All participants received asynchronous lecture materials prior to the simulation. A knowledge check and pre-test confidence survey in tracheostomy management was done. On completion of content review, learners were exposed to a tracheostomy/ventilator-dependent simulation case exhibiting signs of respiratory distress utilizing high-fidelity mannequins. Facilitators used a validated checklist to evaluate competency of critical skills and post-simulation debriefing was conducted. Learners repeated the same case two months later with a post-test survey/knowledge check.

Results:

47 learners participated in the first phase but 18 completed both arms (pre/post)of the study, including pediatric, medicine-pediatric, emergency residents and pediatric hospital medicine fellows/attendings. The M: F ratios was 39:61. Confidence significantly increased from pre to post simulation across all participants (p < 0.0001. An upward trend in increase in knowledge was noted, however, this did not reach significance (p = 0.055). There were no significant differences between total or global checklist scores across participants.

Conclusion(s):

Emergency simulation scenarios specific to the complex care pediatric patient population is a useful educational tool to teach critical skills to health care professionals. The incorporation of simulation will better prepare physicians to provide comprehensive care to this population.