Improving the Pediatric Emergency Department Learning Experience: A Simulation-Based Orientation for Pediatric PGY 1...

Rotations in the pediatric emergency department (PED) may expose residents to very few critically ill patients. In our previous work, interns at our institution showed low self-confidence in decision-making and preparedness to stabilize acutely ill patients. In order to improve this, we designed a new, peer-led, simulation-based orientation to the PED rotation for interns focusing on workflow and decision-making. The cases presented learners with practical and generalizable challenges, such as ordering initial labs and medications and defining the ultimate disposition for the patient.

This orientation curriculum was designed for first-year residents using high-fidelity simulation mannequins. In the first of two cases, learners managed a 10-year-old boy presenting with status asthmaticus who required continuous albuterol and parenteral magnesium to achieve stability for admission. In the second case, a 4-year-old girl with short gut syndrome and an indwelling central line presented with fever, was found to be septic, but responded well to fluid resuscitation and antibiotic therapy.

Over 2 years of implementation, 39 residents participated. Pre- and postintervention Likert-based survey evaluations showed significant increases in confidence in decision-making and preparedness to stabilize acutely ill children that were not seen in a control group during the pilot year. A subsequent class-wide implementation showed similar significant improvements, as well as increased comfort initiating treatment prior to staffing.

Using simulation mannequins in a case-based orientation can improve PGY 1 residents' self-confidence and sense of preparedness during their first rotation in the PED.