A Simulation-Based Approach to Severe Bronchospasm Complicated by Septic Shock

Area of Science:

• Pediatric Emergency Medicine
• Medical Simulation
• Medical Education

Background:

• Managing high-acuity, low-frequency pediatric emergencies is crucial for trainee development.
• Conditions like near-fatal bronchospasm with respiratory failure and uncompensated septic shock demand specialized skills.
• Timely clinical judgment, medication knowledge, and resuscitation strategies are essential for these emergencies.

Purpose of the Study:

• To evaluate the impact of high-fidelity simulation on pediatric residents' confidence in managing critical pediatric emergencies.
• To assess improvements in recognizing and managing near-fatal bronchospasm complicated by septic shock.
• To determine if simulation training enhances confidence across different resident training levels.

Main Methods:

• A high-fidelity, interprofessional simulation was implemented for pediatric residents.
• The simulation focused on managing near-fatal bronchospasm progressing to respiratory failure and uncompensated septic shock.
• Confidence was assessed using a retrospective pre-then-post-simulation survey, with structured prebriefs and PEARLS-guided debriefs.

Main Results:

• Confidence scores significantly improved across all educational objectives (P < .01) among 90 pediatric residents.
• Perceived confidence increased by at least one level in 62% (objective 1), 67% (objective 2), and 72% (objective 3) of residents.
• PGY-1 residents demonstrated the most significant confidence gains, particularly in respiratory support escalation (P = .004).

Conclusions:

• High-fidelity simulation effectively increased pediatric residents' confidence in managing complex, life-threatening pediatric emergencies.
• Simulation serves as a valuable tool for enhancing clinical confidence in treating rare but critical scenarios.
• The training aligns with Kirkpatrick Level 2 learning, indicating improved participant reaction and learning.