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"When in Doubt, Change It out": A Case-Based Simulation for Pediatric Residents Caring for Hospitalized
Erin K Khan1, Tai M Lockspeiser2, Deborah R Liptzin3
1Fellow, Department of Pediatrics, Section of Pulmonology and Sleep Medicine, University of Colorado School of Medicine.
Insights
Pediatric residents can now practice managing tracheostomy emergencies in children using a new simulation. This low-fidelity training effectively prepares them for critical in-hospital scenarios, improving patient safety.
Area of Science:
- Medical Education
- Pediatric Critical Care
- Simulation-Based Learning
Background:
- Caring for technology-dependent children, including those with tracheostomy and ventilator dependence, presents unique challenges for pediatric residents.
- These children face a higher risk of in-hospital complications, necessitating specialized emergency preparedness training.
Purpose of the Study:
- To develop and evaluate a simulation-based curriculum for pediatric residents to manage tracheostomy-related emergencies.
- To enhance residents' ability to recognize and intervene in common complications like tube obstruction or decannulation.
Main Methods:
- A low-fidelity simulation curriculum was designed with three in-hospital cases for pediatric residents.
- Scenarios, environment preparation, materials, and debriefing outlines were provided to instructors.
- Resident feedback was collected via anonymous surveys, and interrater reliability was assessed.
Main Results:
- Twelve senior pediatric residents participated, with 90% reporting the experience as very or extremely helpful.
- The assessment tool demonstrated strong interrater reliability with an intraclass correlation coefficient of 0.93.
Conclusions:
- The low-fidelity simulation was well-received and effective in training residents on tracheostomy emergency management.
- The program is easily executable with minimal resources and instructor training, highlighting the value of just-in-time training and debriefing.
Introduction:
Caring for technology-dependent children, such as those with tracheostomy and ventilator dependence, can be new and frightening for pediatric residents. Education about emergencies in this patient population is important because these children are at risk for in-hospital complications. Safe care of the tracheostomy-dependent child requires the ability to recognize common complications, such as tracheostomy tube obstruction or decannulation, and intervene appropriately by suctioning and/or replacing the tracheostomy tube. This simulation-based curriculum teaches learners to identify and practice the management of these tracheostomy tube complications through low-fidelity simulation exercises.
Methods:
We created a simulation session with three cases reflecting in-hospital scenarios encountered by resident physicians caring for tracheostomy-dependent children in the inpatient setting. The simulation scenario, simulation environment preparation, materials list, and debriefing outline are provided for the instructor for each simulation case. Validity evidence for the assessment tool was obtained by calculating the interrater reliability of two different raters. Resident feedback was obtained through anonymous surveys.
Results:
Twelve pediatric senior residents completed the experience. It received overwhelmingly positive feedback on learner evaluation forms, with 90% finding the experience very or extremely helpful. The intraclass correlation coefficient of interrater reliability for our assessment tool was 0.93.
Discussion:
The simulation was well received by residents. The interrater reliability was acceptable. This low-fidelity simulation exercise can easily be executed with minimal materials or instructor training. High-yield, just-in-time training with postcase debriefing is key to the simulation's success.
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