Repetitive Pediatric Simulation Resuscitation Training
The majority of pediatric residents will complete three years of pediatric training with little or no hands on resuscitation experience (1). In a survey at a tertiary care teaching hospital 44% of senior pediatric residents reported that they had never lead a code at the completion of clinical training. Resident errors were noted during 78% of intubation attempts and only 67% of intraosseous needle placements (2). Successful completion of the two-day Pediatric Advanced Life Support (PALS) course does not result in adequate skills of on-call residents (3). Decay in resuscitation knowledge and skills has been reported at one-year follow-up after the PALS course (4). Nationally the morbidity and mortality associated with Pediatric Cardiopulmonary Resuscitation has not changed significantly over the last three decades with mortality in the 70-85% range for non-ICU resuscitations (5-7).
Trainees are experiencing diminishing exposure to high acuity “code” situations during residency because of work hour restrictions, increasing sub-specialization, and an increased emphasis on primary care. Quality resuscitation education necessitates novel modalities to teach and test pediatric resuscitation in the face of providers not having these experiences during their routine training experiences. Educational sessions that use simulated patients to provide residents experiences with critical illness have resulted in improved confidence and performance (8). Practice with medical simulators boosts skills and is superior to resuscitation course teaching. Simulation has been demonstrated to be equal to real patient exposure to learn highly complex procedures (9).
The traditional format for simulation sessions involves trainees managing a case and subsequently debriefing with a facilitator about their performance. Debriefing and reviewing the videotape of their performance after the case allows for immediate feedback. The errors noted during review are just as valuable to learning as successes, something that is not desirable in real life clinical experiences. Watching your own performance during debriefing raises awareness of aspects of performance largely ignored in other educational modalities. This increases the chance that the learner will perform better when called upon in real life.
While debriefing has proven effective not much is known about the effect of immediate post-debriefing practice on learning. We propose that a chance to apply the feedback discussed in debriefing and correct deficits during an immediate second simulation experience will lead to improved training compared to the standard format. This immediate opportunity to apply knowledge and skills is necessary because the resident is unlikely to have the opportunity to apply this knowledge in the clinical arena.