Sentinel events in pediatric hepatology: A pilot simulation curriculum

Sentinel hepatology events require robust prior experience to accurately diagnose and manage. Given the rarity of complex pediatric liver disease, gastroenterology (GI) fellows do not uniformly get exposure to these patients. We developed a simulation curriculum to ensure exposure to and improve confidence in diagnosis and management of these patients.

Using needs assessment data, a simulation experience was developed, including two clinical scenarios, each mimicking several days of case evolution. Learning objectives included effective communication of diagnostic and management plans to medical teams and families. Targeted didactics were completed between phases. At the conclusion of the experience, fellows scored their confidence levels across learning objectives compared to a retrospective baseline. To assess longitudinal confidence, two similar online clinical cases were disseminated 5 months later with repeat confidence scoring.

Six of eight eligible fellows participated in the simulation experience. All participants reported that the curriculum was meaningful and decreased their anxiety caring for these patients. The collaborative structure fostered psychological safety and mitigated cognitive load. There was a statistically significant increase in self-assessed confidence for all learning objectives after the simulation.

In the current training environment, it is difficult to attain autonomy in managing complex pediatric liver disease. This simulation is the first of its kind in pediatric GI to address diagnosis and management of complex chronic liver disease. The pilot was feasible, impactful, and could help standardize fellow training regardless of program size or transplant center designation, thereby impacting the care of children with liver disease.