VP Shunt Malfunction Simulation Case for Emergency Medicine Residents

This simulation was designed primarily for emergency medicine residents and pediatric emergency medicine residents. Additionally, off-service residents, neurosurgical residents, pediatric residents, faculty, and medical students may benefit.

Ventriculoperitoneal (VP) shunts are the treatment of choice for patients suffering from hydrocephalus. Hydrocephalus affects about 125,000 patients in the United States, and 33,000 VP shunts are implanted in patients every year.1 However, these devices can malfunction and can cause complications. It is important for the emergency department physician to recognize when these devices are not functioning correctly to prevent life-threatening complications. Training for VP shunt malfunction can be variable depending upon the patient population seen by residents. Therefore, we outline a simulation for mechanical VP shunt malfunction to provide learners with exposure to this topic.

The objective of this simulated case is to increase learner knowledge and develop the skills necessary to troubleshoot VP shunt malfunction. By the end of this simulation, learners should be able to: 1) review pertinent historical and physical exam points for a shunt patient, 2) recognize the signs and symptoms of VP shunt malfunction, 3) review an algorithm for diagnosing VP shunt malfunction, 4) discuss treatment for common complications of VP shunt dysfunction, and 5) recall the indications for an emergent VP shunt tap.

In this study, a high-fidelity mannikin with a do-it-yourself (DIY) task trainer was used in a simulated case scenario. Learners were required to recognize the signs and symptoms of shunt dysfunction, administer the appropriate treatment, and appropriately disposition the simulated patient.

Residents completed pre- and post-simulation surveys to assess their perceived knowledge and confidence regarding the diagnosis and management of VP shunt malfunction. To prevent priming or diagnostic cueing, the term "neurologic device" was used in the pre-simulation surveys. This wording may significantly limit direct comparison between pre- and post-simulation responses. Learners were also asked to provide feedback on the utility of the simulation for their future practice and usefulness of the topic.

Learners reported high levels of confidence in recognizing signs and symptoms of shunt dysfunction and managing complications after the simulation. Residents also reported that the case was valuable for their future clinical practice and felt as though the simulation experience was positive.

Overall, the educational content was effective. The simulation appears to be useful in addressing knowledge gaps in managing VP shunt dysfunction and may increase learner confidence.

Medical simulation, ventriculoperitoneal shunt dysfunction, hydrocephalus, pediatrics, increased intracranial pressure, shunt tap, neurologic emergencies.