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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.
Background:
Adrenal crisis (AC) is a rare but life-threatening pediatric emergency requiring rapid recognition and immediate administration of stress-dose glucocorticoids. Because AC is infrequently encountered during clinical training, pediatric and medicine pediatric residents may lack confidence and knowledge regarding timely diagnosis of adrenal insufficiency (AI), sick-day management, appropriate hydrocortisone dosing, and appropriate acute AC management. Simulation-based education provides a controlled environment to address these critical gaps. The objective of this pilot study was to assess the immediate educational impact of a high-fidelity simulation and structured debriefing on resident knowledge of AC recognition and management.
Methods:
Pediatric and medicine-pediatric residents participated in a 45-minute simulation session consisting of a novel, investigator-developed pediatric emergency department scenario involving AC, followed by a structured debrief focused on clinical decision-making, stress-dose steroid administration, dosing, and outpatient sick-day management. Residents completed a four-question knowledge assessment immediately before and after the intervention, with each question addressing a distinct domain of AC management. Responses were coded as correct or incorrect. Paired pre- and post-intervention responses were analyzed using McNemar's test for individual questions and paired tests for composite knowledge scores.
Results:
Thirty-five residents completed paired pre- and post-simulation assessments. Baseline knowledge varied across domains, with particularly low accuracy in outpatient sick-day management (2.9%) and stress-dose hydrocortisone dosing (42.9%). Following the simulation and debriefing, correct response rates improved across all domains, with the greatest gains observed in sick-day management (85.3% post-intervention, p < 0.001) and stress-dose dosing (93.9%, p < 0.001). Recognition of first-line treatment for AC improved from 80.0% to 100% (p = 0.031). Mean composite knowledge scores increased significantly from 2.11 to 3.66 out of 4 (p < 0.001).
Conclusions:
A single simulation-based educational intervention with structured debriefing was associated with improved immediate knowledge of AC recognition and management among pediatric and medicine pediatric residents. Further studies are needed to evaluate long-term retention and translation to clinical performance.
