Using simulation to teach paediatric complex care

Training paediatric residents regarding the care of children with medical complexity (CMC) remains an important challenge given how frequently these patients are treated by trainees and the lack of educational activities specific to these patients. Our goal was to develop and assess a novel simulation regarding the acute care of CMC to improve residents' perceived confidence in areas related to CMC care.

We developed a case of a patient with multiple chronic medical conditions who presented with acute vital sign changes and worsening discomfort due to an occult femur fracture related to a recent transfer. Paediatric residents worked in teams to complete a full physical exam, create a differential diagnosis, evaluate laboratory and imaging results and create a management plan.

Thirty-three residents out of a total possible sample of 97 (34%) participated in the simulation, which was evaluated using pre- and post-surveys immediately before and after the simulation assessing resident confidence completing tasks related to CMC care. Residents perceived significant improvement in confidence regarding evaluating a differential diagnosis of vital sign and exam changes in CMC (p = 0.023), managing vital sign and exam changes in CMC (p = 0.009) and communicating with team members of CMC (p = 0.049).

An innovative high-fidelity and low-stakes simulation was effective in teaching trainees about acute management of concerns related to CMC. This simulation may be appropriate for implementation at other institutions, serving as a foundation for use in resident education regarding CMC.