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In situ Simulation as a Training Tool in a Tertiary Pediatric Emergency Department in Italy: Enhancing Preparedness
Valeria Pansini1, Lavinia Capossela2, Elena Pende2
1Department of Women's and Children's Health Sciences, Institute of Pediatrics of Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Background:
In situ simulation differs from in-centre simulation as it is conducted in the actual clinical environment rather than a simulation laboratory, thereby enhancing contextual realism and enabling identification of system-level vulnerabilities within clinical workflows.
Objective:
To evaluate the impact of in situ simulation on self-perceived competence, clinical performance, team dynamics, and system readiness in a tertiary pediatric emergency department in Italy.
Methods:
This prospective single-center observational study was conducted in a tertiary pediatric emergency department in Italy. A total of 55 healthcare professionals participated in 11 high-fidelity in situ simulation sessions. Participants completed pre- and post-intervention self-assessment questionnaires using a Likert-scale instrument developed for the study. Clinical performance was evaluated using a structured ABCDE-based checklist. No formal qualitative interviews were conducted. Statistical analysis was performed using paired t-tests with a significance threshold of p<0.05.
Results:
Significant improvements were observed across all assessed domains, particularly in ABCDE assessment, ventilation, and defibrillator use (p<0.001). Junior residents and participants without recent EPALS certification demonstrated the greatest improvement. In situ simulation also identified latent safety threats related to equipment availability and clinical workflow.
Conclusion:
In situ simulation improves perceived clinical competence and team performance while providing actionable insights into system-level safety vulnerabilities. Future research should incorporate objective performance metrics and validated assessment tools.
