Medical Education: Simulation & Technology
Medical Education 9: Simulation & Technology 2
Thomas P. Conway, DO (he/him/his)
Pediatric Emergency Medicine Fellow
Cohen Children's Medical Center
Astoria, New York, United States
The acute management and resuscitation of pediatric trauma is a core topic for pediatric resident education and the current literature shows a gap in trauma education. At our own institution, the pediatric residents have a paucity of experience performing trauma assessments owing to their lack of certification in Advanced Trauma Life Support Course (ATLS).
We aimed to develop a curriculum for the pediatric residents that focuses on the primary survey. The objective of our curriculum was to increase resident confidence in all aspects of the primary survey, as well as demonstrate competence in completing the primary survey on a simulated trauma patient.
Our curriculum employed a style of simulation termed rapid-cycle, deliberate practice (RCDP). RCDP cases progress with frequent pauses for corrective actions or reinforcement of key steps. A scripted trauma case was developed, with critical action steps that correlated with the key aspects of the primary survey. To study the effectiveness of this curriculum, Kirkpatrick 1-3 level data were collected via two instruments. First, subjective survey and objective quiz were created and administered at baseline, immediately after participating in the simulation activity, and approximately 6-months after simulation. Second, a checklist was created to evaluate learner’s ability to complete the primary survey on a simulated patient, immediately after the intervention, as well as at the 6-month interval.
Out of 100 pediatric residents initially enrolled in the program, 80 completed pre and post simulation surveys and metrics; distribution was comparable among PGY 1, 2 and 3 level residents. Results show that there was a significant increase in confidence immediately after the RCDP simulation (mean (SD): 31.8 (15.9), p< 0.0001). However, there was also a slightly decrease noted between the measured confidence levels immediately post simulation and 3-6 months later (p=0.04). Trauma checklist results showed that immediately post-intervention, residents missed an average of 1.8 items out of the 25 in the primary survey and 3-6 months later, missed an average of 8.5 items.
Use of RCDP simulation teaching is an effective method to increased confidence, increase knowledge, and provide residents with skills to complete the primary survey. Given drop-off, refreshers may be beneficial for skill retention over time; future studies may aim to identify the optimal interval of such interventions. The payoff of these educational efforts will be a future generation of pediatricians competent in basic trauma assessments.