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Bridging the gap in adrenal crisis management: a pilot simulation-based pre post educational intervention to improve
Ortal Resnick1, Leen Matalka2, Christy Foster2
1Division of Pediatric Endocrinology and Diabetes, University of Alabama at Birmingham, Children's Park Place, CPP M30, 1600 4th Avenue South, Birmingham, AL, 35233, USA. oresnick@uabmc.edu.
BMC Medical Education
|July 17, 2026
Summary
Pediatric residents showed improved knowledge of adrenal crisis (AC) management after a simulation. The training enhanced understanding of sick-day management and hydrocortisone dosing, crucial for this rare pediatric emergency.
Area of Science:
- Pediatric Emergency Medicine
- Medical Education
- Endocrinology
Background:
- Adrenal crisis (AC) is a life-threatening pediatric emergency requiring prompt recognition and glucocorticoid treatment.
- Pediatric residents often lack sufficient knowledge and confidence in managing AC due to its rarity.
- Simulation-based education offers a controlled environment to improve AC recognition and management skills.
Purpose of the Study:
- To assess the immediate educational impact of high-fidelity simulation and debriefing on resident knowledge of AC.
- To evaluate improvements in recognizing adrenal insufficiency (AI) and managing AC.
- To measure changes in understanding of sick-day management and hydrocortisone dosing.
Main Methods:
- Pediatric and medicine-pediatric residents participated in a 45-minute simulation scenario focused on AC.
- A structured debriefing session followed the simulation, covering clinical decision-making and management strategies.
- Residents completed a four-question knowledge assessment immediately before and after the intervention.
Main Results:
- Knowledge assessment showed significant improvement across all domains after the simulation.
- Accuracy in outpatient sick-day management increased from 2.9% to 85.3% (p<0.001).
- Stress-dose hydrocortisone dosing accuracy improved from 42.9% to 93.9% (p<0.001), and composite scores rose significantly.
Conclusions:
- A single simulation with debriefing effectively improved immediate resident knowledge of AC recognition and management.
- The intervention demonstrated particular success in enhancing knowledge of sick-day management and dosing.
- Further research is needed to assess long-term knowledge retention and clinical practice translation.
