116 Emergency Medicine Resident Attitudes Surrounding Resuscitation of a Critically Ill Child: Overcoming Obstacles Using a Novel Form of Simulation

C. Theiler; K. Harland; D. Miller; N. Shekem

doi:10.1016/j.annemergmed.2024.08.121

Study Objectives Although pediatric (peds) patients make up approximately 20% of all emergency department visits in the USA, Emergency Medicine (EM) residents have limited exposure to critically ill children. Despite this, after graduation, they are expected to be an expert in the management of ALL acute and life-threatening conditions. Both Pediatric and EM governing bodies have acknowledged the importance of peds-specific education in EM residency training, but given the low frequency of actual clinical exposure, training programs cannot rely solely on clinical experiences. At our institution, we observed that despite the need for more peds experience, when given the opportunity to care for a critically ill child, EM residents were less likely to step into the team leader role compared to similar adult scenarios. This phenomenon has also been described by others, and we hypothesized that it was largely due to lack of peds-specific knowledge & skill limitation due to infrequency. We aimed to better understand EM residents’ experience and perceived barriers to taking on the team leader role in the resuscitation of a critically ill child; and through a novel form of simulation involving Rapid Cycle Deliberate Practice (RCDP) and rotating hands-on skill simulation stations, we sought to improve residents’ confidence and skill in the team leader role, as well as improve their knowledge of peds-specific equipment and procedures. Methods This study took place at a tertiary care institution with a 3-year EM residency. Residents participated in a half-day workshop consisting of small groups rotating through a simulated peds cardiac arrest case and four separate hands-on peds airway skill simulation stations, with RCDP used at each. Residents took a survey immediately after the session to 1) assess baseline experience and attitudes, and 2) assess the impact of the curriculum on learner confidence and perceived skill in peds resuscitations, comparing pre- and post-workshop levels in 16 categories using a 5-point Likert scale, with assessment of mean difference using a paired t-test, with p value < 0.05 being statistically significant. Results 21 EM residents participated. Average age was 30 years, 62% were male, all but one was PALS certified. The majority (86%) had participated in <10 peds resuscitations, and even fewer had taken on the team leader role; in contrast to adult resuscitations in which the majority had participated in >15. Residents cited not having enough experience and lack of expertise with peds medication dosing as the primary obstacles that might prevent them from taking on the team leader role in a peds resuscitation. Following the workshop, residents had a statistically significant improvement in mean confidence level and perceived skill in peds resuscitations in 12/16 categories. 80% reported an increase in confidence level and skill as team leader, 90% reported an improvement in communication skills, and 67% reported an improvement in their ability to manage the peds airway. Conclusion Peds-specific education is an important part of EM residency training, however actual clinical exposure to critically ill children is limited. We found that EM residents had participated in far fewer peds resuscitations compared to adult, and identified lack of experience & lack of peds medication dosing expertise as barriers to taking on the team leader role. Following participation in a novel half-day workshop using RCDP and consisting of rotation through a peds cardiac arrest simulation and four hands-on peds airway skill simulation stations, EM residents had a statistically significant improvement in mean confidence level & perceived skill surrounding peds resuscitations.

116 Emergency Medicine Resident Attitudes Surrounding Resuscitation of a Critically Ill Child: Overcoming Obstacles Using a Novel Form of Simulation

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