476 - Staying Alive; Addressing the Educational Gaps Between the See One, Do One Bag Mask Ventilation Teaching with Simulation

Historically, medical education has taken a very linear path. Pre-clinical lectures transitioned into the "see one, do one, teach one" mindset of the clinical years. With the introduction of the culture of safety in the past few decades, medical education changed to fill in the educational gap between "see one" and "do one." This is where simulation-based medical education (SBME) has flourished. High fidelity simulation is often thought of as the ideal tool for teaching; however, its expense and scheduling needs can obviate rapid cycle deliberate practice or just-in-time training. 


Objective: This project proposes to teach medical students in their third year, principles of bag-mask ventilation (BMV) through the conceptual framework of deliberate practice, specifically rapid cycle deliberate practice (Figure 1).

Design/Methods:

The rapid cycle deliberate practice coaching session was required for third-year medical students during their intersession course. Using low fidelity task trainers for simulation, the team used the Helping Babies Breathe (HBB) Checklist, to assess the student's initial technique of BMV and their final technique after rapid cycle deliberate practice coaching. The HBB Checklist, is published through the American Academy of Pediatrics and is scored out of 14 points.


Results:

We were able to achieve our initial goal and have successfully integrated this simulation into four one-hour sessions. 120 students participated in this teaching session. Paired t test found an improvement in the pre to post test scores (14 possible points); Mean Pre= 9.05, Mean Post= 12.54 paired t test p < 0.00001, 95% CI (-4.08, -2.89) (Figure 2). We also found 56% of the students had incorrect hand placement, placing their fingers over the submental space when attempting BMV (Figure 3). Additional inquiry into this finding found that the students were taught this hand positioning during their adult BMV classes, further solidifying the necessity of specific pediatric skills classes.


Conclusion(s):

We were able to achieve our initial goal and have successfully integrated this simulation into four one-hour sessions. By integrating the simulation into an already established intersession we are able to produce a sustainable simulation curriculum. We saw a significant improvement in BMV skills after our teaching intervention. We also found a significant number of students using incorrect hand placement for bag mask ventilation, which would impede airflow into the neonatal airway. Students were also able to improve their skills on corrective steps to re-establish ventilation after the teaching session.