Repeated versus varied case selection in pediatric resident simulation.
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ABSTRACT:
SUBMITTER: Tofil NM
PROVIDER: S-EPMC4054726 | biostudies-other | 2014 Jun
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:Near-peer teaching is effective in graduate medical education, but it has not been compared with faculty member teaching in resident simulation. In this study, we sought to compare debriefing sessions of internal medicine (IM) intern simulation sessions led by academic faculty doctors with those led by senior IM residents in order to measure the effectiveness of near-peer teaching in this setting. Near-peer teaching is effective in graduate medical education, but has not been compared with faculty member teaching in resident simulation METHOD: Internal medicine interns participated in four simulation cases, two of which were debriefed by faculty members and two of which were debriefed by residents. Pre-simulation knowledge assessment was completed prior to the case. Following each debriefing, interns completed a Debriefing Assessment for Simulation in Healthcare (DASH) survey. Post-simulation knowledge assessments were completed 6 months after simulation. Debriefings were recorded and transcribed. Each statement made during debriefing was classified as either correct or erroneous by blinded reviewers. RESULTS:Fifty interns participated in simulation, and the response rate on the DASH survey was 88%. There was no difference between DASH scores (p = 0.13), post-simulation knowledge assessments or error rates during debriefing (p = 0.31) for faculty member and resident instructors. CONCLUSION:Our study suggests that residents and faculty members provide a similar quality of simulation instruction based on qualitative and quantitative evaluation.
| S-EPMC5955800 | biostudies-literature
Project description:Introduction:We sought to evaluate pediatric oncology simulations intended to improve pediatric residents' skills and comfort in caring for children with cancer. Method:In a non-randomized trial, controls (the first three rotations) received a standard set of lectures, and the intervention arm received these lectures plus five simulation-training scenarios-fever/neutropenia, a new leukemia diagnosis, end-of-life care discussion, tumor lysis syndrome, and a mediastinal mass. All residents were tested after the rotation on the first three scenarios; management skills were evaluated independently by two raters. Before and after training, all residents completed an emotional-appraisal questionnaire evaluating each scenario as a perceived challenge or threat. Analysis of variance (ANOVA) measured differences by study arm in skills-checklist assessments and appraisals; repeated-measures ANOVA measured changes in emotional-appraisal scores. Results:Forty-two residents (9 control, 33 intervention) participated. Inter-rater agreement for skills-checklist scores using average-measures intraclass correlation was high (0.847), and overall mean scores were significantly higher for the intervention than control group across both raters (P = 0.005). For all residents, perceived challenge increased in the end-of-life simulation, and perceived threat decreased in all three test scenarios. The intervention group, regardless of training year, evaluated the teaching scenarios favorably and felt that challenging oncology situations were addressed, skills were enhanced, and the simulations should be offered to other residents. Conclusions:It was feasible to introduce residents to difficult pediatric oncology scenarios using simulation. The intervention group performed more skills than controls when tested, and perceive threat declined in all residents after their pediatric oncology rotation.
| S-EPMC6724731 | biostudies-literature
Project description:IntroductionUnintentional toxic ingestions are a common occurrence in the pediatric population, and it is therefore important for resident physicians to learn to both recognize and effectively manage these events. Seizures caused by isoniazid overdose are a well-described clinical entity for which pyridoxine serves as an effective antidote. We developed a pediatric simulation case using a high-fidelity patient simulator to engage learners in a case of status epilepticus in a toddler caused by accidental isoniazid ingestion.MethodsThe learning objectives of this activity are for participants to recognize that toxic ingestion has occurred, execute appropriate initial management of status epilepticus, and administer pyridoxine as an antidote. Equipment and personnel needed for this activity include a high-fidelity patient simulator, simulated medical supplies, a patient simulator operator, and one actor.ResultsThis simulated case debuted among resident physicians at a simulation competition event within the emergency medicine residency program of an academic medical center. Feedback elicited after the event included a high proportion of respondents agreeing that the cases used were "sufficiently complex" and "relevant for my clinical practice."DiscussionDespite some barriers to effective implementation, this simulation case was well received and may serve as a valuable educational tool for training resident physicians to effectively manage toxic ingestions. The effectiveness of this simulation in accomplishing its specific learning objectives was not formally assessed, but participant evaluations suggest that it was well received by its target audience.
| S-EPMC6338183 | biostudies-literature
Project description:A robust selection process is critical to residents' "cultural fit" and success in their program. Traditional selection methods have shortcomings.We describe a novel residency interview process for obstetrics-gynecology residents that incorporates behavioral, group, and surgical simulation multiple mini interviews (MMIs).In 2010, the Cedars-Sinai Medical Center obstetrics-gynecology residency program developed surgical simulation, role play, ethics group interview, and Accreditation Council for Graduate Medical Education competency-based behavioral interview stations.From 2010 to 2012, a total of 199 applicants were interviewed, 62 ranked in the top 20, and 18 matched into the program. The MMI scores for interview stations were used in compiling our rank list and were found to adequately differentiate candidates. The MMI mean scores for role play, ethics interview, surgical simulation, and the behavioral interview for the top 20 ranked candidates were statistically significantly higher than those for other applicants. Standardized tests minimally correlated with various interview modalities. Applicants found the interview process acceptable. Implementing these MMI stations increased the total applicant interview time for the day by 15% (from 5.5 to 6.5 hours) and increased the face-to-face interview time from 2 to 4 hours. Approximately 42 hours of coordinator time was required for the yearly interview cycle.A multifaceted interview process utilizing MMI, group interview, and surgical simulation MMI is feasible and acceptable. The approach may decrease subjectivity and reliance on traditional interview methods and facilitate the selection of "compatible" residents into the program.
| S-EPMC4936861 | biostudies-other
Project description:Pediatric residents report a lack of confidence and competence with procedural skills at graduation. Training programs could benefit from improved approaches to target these needs. Using the Institute for Healthcare Improvement (IHI) Model for Improvement and three Plan-Do-Study-Act (PDSA) cycles, we examined the impact of a procedure simulation boot camp on self-reported procedural confidence and competence as well as the longitudinal impacts of these sequential interventions on Accreditation Council for Graduate Medical Education (ACGME) Graduating Resident Survey (GRS) results.Three rapid cycle interventions were performed in successive academic years. The interventions included 1) increased awareness of available procedural experiences, 2) institution of procedural educational conferences, and 3) implementation of a senior resident procedure boot camp. Senior resident self-reported procedural confidence was measured before and after the boot camp. Procedural competence was measured using the ACGME GRS. Results: Thirty-two of 34 senior residents (94%) completed the 2016 ACGME GRS, similar to the response rates of 2014 (92%) and 2015 (94%), and 30 of 34 third-year residents participated in the procedure boot camp (88%). Resident confidence and competence with procedural skills improved after the institution of the quality improvement intervention. ACGME GRS-reported competency increased in bag and mask ventilation (77% to 94%), neonatal endotracheal intubation (39% to 69%), peripheral IV placement (10% to 50%), and umbilical catheter placement (35% to 53%).A quality improvement intervention with three rapid PDSA cycles was successful in improving senior pediatric resident confidence and competence with ACGME required procedural skills.
| S-EPMC5493469 | biostudies-other
Project description:Introduction:While family-centered rounds (FCR) have become increasingly important in pediatrics, there is often no training for residents on appropriate FCR practice. This curriculum was developed to address this identified gap in pediatric trainee education through a combination of didactic presentation, direct observation, and simulated FCR. Methods:Residents participated in a didactic presentation on key components of FCR and tenets of communication with families. A subset of residents participated in a simulated intervention in which they practiced an FCR encounter using a mock patient case and received immediate feedback from a multidisciplinary team. Following the simulation, residents completed follow-up surveys and focus group discussions to assess their experience and comfort. Resident trainees were observed and rated during FCR by trained parent advisors using a novel FCR checklist both before and after participation in the simulation. Results:This curriculum was implemented with 10 pediatric interns (intervention group). These residents demonstrated statistically significant improvements in the areas of greeting family by name and soliciting rounding preferences, enhancing family comfort in participating in FCR, and increasing family engagement in FCR. Compared to controls, intervention group residents had higher ratings on the majority of performance items. Resident-reported self-efficacy in conducting FCR increased following the intervention, and the feedback portion of the intervention was highly valued. Discussion:Simulation-based training is an effective model for teaching residents best practices in FCR with lasting impact on resident communication skills as seen in comparative analysis from before and after the intervention.
| S-EPMC6346277 | biostudies-literature
Project description:IntroductionVolume depletion is a common problem in pediatrics. Interns need to be able to recognize critical illness such as hypovolemic shock, obtain access, and manage complications. This simulation case involves a child with hypovolemic shock who requires intraosseous (IO) needle placement. While designed for subinterns in pediatrics, it is relevant for clerkship students and interns in family medicine and emergency medicine.MethodsIn this case, a 3-year-old child presents with vomiting, diarrhea, and lethargy, and is in hypovolemic shock. As IV access cannot be obtained, he requires IO access. Laboratory results reveal hypoglycemia, hypernatremia, and acute kidney injury. Required equipment includes an IV arm task trainer and a child mannequin with IO capacity (or a child mannequin plus a separate IO task trainer). Learning objectives include recognizing and managing hypovolemic shock, hypoglycemia, and electrolyte disturbances; obtaining IO access; and communicating with a distraught parent. Critical actions include attempting IO access, requesting labs, and administering fluids. Students complete a selfassessment survey following the case.ResultsA pilot study was conducted in 2017 with all subinterns (N = 16) on the pediatric service. Students' perceived competence in assessment and management of volume depletion and procedural skills such as IO placement were high following the session, and students rated the case as a highly beneficial learning experience.DiscussionThis clinical simulation case allows students to demonstrate clinical reasoning skills, procedural skills, and management skills regarding hypovolemic shock. It may be used as part of a curriculum for fourth-year students entering pediatric residency.
| S-EPMC6342355 | biostudies-literature
Project description:ObjectiveTo evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students.Methods33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g.ResultsBoth groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).ConclusionHFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.
| S-EPMC11331236 | biostudies-literature
Project description:IntroductionThis activity is designed for midlevel and senior anesthesia trainees to experience the complexities of one-lung ventilation in pediatrics in a high-fidelity simulated environment. With the use of video-assisted thoracoscopic surgery (VATS) becoming increasingly common in pediatrics, we identified this area as an opportunity for the development of a dedicated educational simulation activity.MethodsOur simulated patient is a 3-year-old girl with empyema presenting for decortication via VATS who subsequently develops hypoxemia. The main challenges for the trainee include airway selection and insertion, lung isolation with fiber optic confirmation, and management of hypoxemia in the setting of one-lung ventilation. A pediatric medical simulator suitable for practicing resuscitation is required, and a tracheobronchial tree model is highly desirable. Basic knowledge of thoracic and pediatric anesthesia is required, but specific experience with pediatric lung isolation is not.ResultsLearners who experienced the content of this simulation expressed a strong sentiment of value. All pilot trainees were surveyed and indicated they either agree or strongly agree (4 or 5, respectively, on a 5-point Likert scale) that "This simulation enhanced my understanding of how to select lung isolation devices for pediatric patients" and "This simulation enhanced my understanding of how to manage hypoxia in context in one-lung ventilation." Comments were overall positive, including "I am better prepared to manage pediatric one lung ventilation cases."DiscussionAt the University of Iowa, this activity is part of a core curriculum of simulation training that resident physicians in anesthesiology experience during their training. It functions as a tool for education, evaluation, and self-identification of weaknesses in the learner's knowledge base as it relates to the perioperative management of pediatric one-lung ventilation, as well as for reinforcing material learned in the classroom and operating room. Numerous anesthesiology residents and faculty have pilot-tested this simulation, and necessary modifications have been made based on their feedback.
| S-EPMC6464470 | biostudies-literature
Project description:IntroductionSeizures in the setting of isoniazid (abbreviated INH, from isonocotinylhydrazide) toxicity can be intractable and persistent despite treatment with the usual status epilepticus (SE) medications. If not recognized in a timely fashion, SE can lead to significant morbidity and mortality. This simulation scenario instructs emergency medicine and pediatric residents and fellows in any year of training on the principles and management strategies of approaching a pediatric patient with SE due to INH toxicity.MethodsThis scenario presents a 5-year-old pediatric patient brought into the emergency department after a witnessed seizure at home, another en route to the emergency department, and a third event in front of the medical provider. This scenario was designed to include one 15- to 20-minute group simulation session, followed by a 10- to 15-minute debriefing of the case. The simulation can be run with a minimum of two participants-one to play the role of physician and the other to play the case director or simulation operator. Also included are visual stimuli consisting of relevant lab results, imaging, and other diagnostic studies. Finally, an educational handout created for all simulation participants reviews important teaching points related to the case.ResultsTo date, 30 residents have participated in this simulation during one of the weekly conference days. In the postactivity survey reviews, residents have reaffirmed their appreciation for their simulation time and have requested more exposure.DiscussionSimulation scenarios are an ideal teaching tool for rare and life-threatening diseases, as medical trainees will have little to no prior applied experience with such conditions.
| S-EPMC6440414 | biostudies-literature