Using screen-based simulation to improve performance during pediatric resuscitation.

To assess the ability of a screen-based simulation-training program to improve emergency medicine and pediatric resident performance in critical pediatric resuscitation knowledge, confidence, and skills. A pre-post, interventional design was used. Three measures of performance were created and assessed before and after intervention: a written pre-course knowledge examination, a self-efficacy confidence score, and a skills-based high-fidelity simulation code scenario. For the high-fidelity skills assessment, independent physician raters recorded and reviewed subject performance. The intervention consisted of eight screen-based pediatric resuscitation scenarios that subjects had 4 weeks to complete. Upon completion of the scenarios, all three measures were repeated. For the confidence assessment, summary pre- and post-test summary confidence scores were compared using a t-test, and for the skills assessment, pre-scores were compared with post-test measures for each individual using McNemar's chi-square test for paired samples. Twenty-six of 35 (71.3%) enrolled subjects completed the institutional review board-approved study. Increases were observed in written test scores, confidence, and some critical interventions in high-fidelity simulation. The mean improvement in cumulative confidence scores for all residents was 10.1 (SD +/-4.9; range 0-19; p < 0.001), with no resident feeling less confident after the intervention. Although overall performance in simulated codes did not change significantly, with average scores of 6.65 (+/-1.76) to 7.04 (+/-1.37) out of 9 possible points (p = 0.58), improvement was seen in the administering of appropriate amounts of IV fluids (59-89%, p = 0.03). In this study, improvements in resident knowledge, confidence, and performance of certain skills in simulated pediatric cardiac arrest scenarios suggest that screen-based simulations may be an effective way to enhance resuscitation skills of pediatric providers. These results should be confirmed using a randomized design with an appropriate control group.

Biese KJ ，Moro-Sutherland D ，Furberg RD ，Downing B ，Glickman L ，Murphy A ，Jackson CL ，Snyder G ，Hobgood C ... -  《-》

Effect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial.

Donoghue AJ ，Durbin DR ，Nadel FM ，Stryjewski GR ，Kost SI ，Nadkarni VM ... -  《-》

A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation.

The objective was to determine if a medical simulation-based neonatal resuscitation educational intervention is a more effective teaching method than the current emergency medicine (EM) curriculum at one 4-year EM residency program. A prospective, randomized study of second-, third-, and fourth-year EM residents was performed. Of 36 potential subjects, 27 residents were enrolled. Each resident was assessed at baseline and after the intervention using 1) a questionnaire to evaluate confidence in leading adult, pediatric, and neonatal resuscitation and prior neonatal resuscitation experience and 2) a neonatal resuscitation simulation scenario in which each participant was the code leader to evaluate knowledge and skills. Assessments were digitally recorded and reviewed independently by two Neonatal Resuscitation Program (NRP) instructors using a validated neonatal resuscitation scoring tool. Controls (15 participants) received the current EM curriculum. The intervention group (12 participants) experienced an educational session, which incorporated didactics, skills station, and medical simulation about neonatal resuscitation. Outcomes measured included changes in overall neonatal resuscitation score, number of critical actions, time to initial steps of neonatal resuscitation, and changes in confidence level leading neonatal resuscitation. Baseline neonatal resuscitation scores were similar for the control and intervention groups. At the final assessment, the intervention group's neonatal resuscitation score improved (p = 0.016) and the control group's score did not. The intervention group performed 2.31 more critical actions overall and the time to achieve warming (p = 0.0002), drying (p < 0.0001), tactile stimulation (p = 0.002), and placing a hat on the patient (p <0.0001) were also improved compared to controls. At the baseline assessment, 80% of the control group and 75% of the intervention group reported being "not at all confident" in leading neonatal resuscitation. At the final assessment, the proportion of residents who were "not at all confident" leading neonatal resuscitation decreased to 35% in the intervention group compared to 67% of the control group. The majority of the intervention group (65%) reported an increased level of confidence in leading neonatal resuscitation. Medical simulation can be an effective tool to assess the knowledge and skills of EM residents in neonatal resuscitation. Our simulation-based educational intervention significantly improved EM residents' knowledge and performance of the critical initial steps in neonatal resuscitation. A medical simulation-based educational intervention may be used to improve EM residents' knowledge and performance with neonatal resuscitation.

Lee MO ，Brown LL ，Bender J ，Machan JT ，Overly FL ... -  《-》

Impact of a pediatric primary care office-based mock code program on physician and staff confidence to perform life-saving skills.

Toback SL ，Fiedor M ，Kilpela B ，Reis EC ... -  《-》

Using pediatric advanced life support in pediatric residency training: does the curriculum need resuscitation?

Grant EC ，Marczinski CA ，Menon K 《Pediatric Critical Care Medicine》