Effectiveness of Iterative Practice in Pediatric Simulation at a Community Hospital

Objective The goal of this study was to improve knowledge and teamwork within a limited simulation period. We hypothesized that implementing iterative practice will increase pediatric resuscitation knowledge and specific team behaviors by 10%. Methodology We implemented an in situ, multidisciplinary, high-fidelity simulation curriculum, in which the scenario was repeated. This study tracked improvements through three multiple-choice questionnaires. Data collected over two years were analyzed using McNemar's test to compare paired binary variables and the Wilcoxon signed-rank test to compare paired ordinal variables. Results A total of 99 questionnaires were completed. Knowledge of indications for cardiopulmonary resuscitation in children improved by 12% (n = 12, p = 0.008); chest compression-to-ventilation ratio in adolescents increased by 16% (n = 16, p = 0.005); chest compression-to-ventilation ratio in children improved by 11% (n = 11, p = 0.03); and ventilation rate with an advanced airway increased after both simulations by 22% (n = 22, p < 0.001) and then by 13% (n = 13, p = 0.004). Statistically significant improvements were not observed for choosing the correct shockable rhythms. All team behaviors improved: information was "always" received by 81% (n = 80) of participants and increased to 94% (n = 93, p < 0.001); self-identification improved from 66% (n = 65) of participants to 87% (n = 86, p < 0.001); and leader identification was noted by 73% (n = 72) of non-leader participants and increased to 88% (n = 87, p < 0.001). Conclusion Iterative simulation practice effectively enhances proximal knowledge and pediatric resuscitation team performance in community hospitals. Future research should explore the simulation frequency needed to retain this knowledge and these skills.