Impact of Participation in Simulated Patient Resuscitations On Pediatric Residents' Confidence

Abstract

Introduction: Given the infrequency of pediatric cardiorespiratory arrests, the knowledge, skills and confidence necessary for leading a successful resuscitation of acutely ill children must be taught through a curriculum designed to provide pediatric residents with the experiences they require, but are unlikely to obtain exclusively at the bedside. Currently, pediatric residents feel their knowledge and skills in pediatric resuscitation are insufficient, and lack confidence in their ability to manage pediatric cardiorespiratory arrests. New evidence suggests that a simulation-based curriculum might have a significant impact on confidence. The objective of this study was to formally assess the impact of participation in simulated pediatric cardiorespiratory arrests on pediatric resident confidence. Methods: Pediatric residents at the University of Calgary participated in four different structured simulated resuscitations during the study. Confidence assessment questionnaires were completed by all residents pre and post simulated patient encounters. Residents were asked to record their confidence on a visual analog scale for 32 different aspects of resuscitation, including leadership and communication skills, technical skills, clinical skills, and specific resuscitation knowledge. Results: Statistically significant increases in confidence were measured across all aspects of resuscitation care: clinical skills (61.3 vs 73.4, 20% increase; p<0.001), technical skills (40.7 vs 63.0, 68% increase; p=0.001), knowledge (43.8 vs 63.5, 45% increase; p<0.001) and leadership (38.1 vs 65.0, 72% increase; p<0.001). Specific items that showed the most significant improvement were: confidence in the ability to perform defibrillation (172%), synchronized cardioversion (139%) and needle decompression (70%); confidence in the ability to manage pulseless arrest (56%) and wide complex tachycardia (55%); and confidence in the ability to establish self as leader of the code team (105%), retain control of the code team (86%), make definitive decisions during a resuscitation (76%), communicate clearly (70%), establish crowd control (66%), elicit feedback from team members (62%) and use team members effectively (62%). As a group, leadership skills showed the most significant improvement overall, with all 8 of the leadership items in the top 10. Discussion: The most significant increases in confidence were found in items dealing with critical elements of resuscitation team leadership and elements needed to manage the most infrequent events in the pediatric population. Significant increases were also seen in the other domains of resuscitation: knowledge, technical skills and clinical skills. This supports using simulation in improving confidence in managing infrequent events and infrequently used skills.