Council on Medical Student Education in Pediatrics

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COMSEP 2012 Indianapolis Meeting

Poster Presentation:


Pediatric Emergencies: A simulation curriculum for medical students and residents

Authors:
Ilana Harwayne-Gidansky, MD - Mount Sinai Kravis Children's Hospital; Alexandra Pfeffer-Leider, MD - Mount Sinai Kravis Children's Hospital; Sheemon Zackai, MD - Mount Sinai Kravis Children's Hospital; Christopher Strother, MD - Mount Sinai Medical Center; Blair Hammond, MD - Mount Sinai Kravis Children's Hospital

Background: Crisis resource management (CRM) is an established part of many training programs. Pediatric crises occur less often than in other specialties and are uniquely stressful and different than adult crises. However, because of their rare occurrence students and residents have few exposures to these situations and are often ill prepared when they arise. This makes CRM under simulation an even more important, yet under-studied area of training and research.

Objective: Our primary objective is to design a curriculum for third year medical students, incorporating exposure to a pediatric resuscitation using a high-fidelity simulator in order to practice both manual skills (effective bag valve mask ventilation), and communication skills (CRM). Second is to assess students' baseline knowledge and attitudes regarding pediatric resuscitation prior to the intervention, and improvement following intervention.

Design/Methods: We designed a curriculum to train third-year medical students in CRM and basic components of resuscitation. This consisted of a lecture and a simulated pediatric arrest scenario, which is repeated three times by the group to build and demonstrate success.. Students completed a pre-test prior to their simulation experience, and a post-test immediately following their simulation experience, Attitudes about CRM were assessed using a 5-point Likert scale (1= strongly agree, 5= strongly disagree).

Results: Fifty-four students have participated in our study thus far. Students showed subjective improvement in their comfort level in a pediatric resuscitation (p<0.001, 95% CI 1.14-1.78), their confidence in communicating during a pediatric resuscitation (p<0.001, 95% CI 1.30-2.13), and their confidence in knowing what their role is during a pediatric resuscitation (p<0.001, 95% CI 1.75-2.46).

Conclusions: CRM is known to improve providers' knowledge, attitudes, and practice. Most studies in the literature assess medical housestaff or nurses. Medical students represent a critical yet under-studied population in both simulation and CRM. These preliminary results suggest a subjective improvement in attitudes surrounding pediatric crises including comfort level, communication, and understanding of roles.

A curriculum teaching crisis resource management to third-year medical students improves their confidence level in a pediatric arrest.