Rapid Cycle Deliberate Crisis Resource Management: Improving Pediatric Trainee Competence and Confidence with a Sustainable Simulation Curriculum (1090-003901) (Research Abstract Oral: Other)
Start time: Tuesday, January 26, 2021, 9:30 AM End time: Tuesday, January 26, 2021, 10:30 AM Session Type: Research Abstracts (Completed Studies)
Pediatrics resident physicians self-report low confidence in approaching and leading acute crisis scenarios1. A specific needs assessment of our pediatric residency program found that the residents lack crisis leadership experience and skills. Crisis resource management (CRM) principles focus on non-technical skills which help the team leader manage a crisis2. We sought to impart these skills upon the resident physicians to address the specific needs of the program. However, the residency program has minimal time to devote to this specific education. We turned to rapid cycle deliberate practice (RCDP), a debriefing method where learners cycle between deliberate practice and directed feedback, to efficiently educate the learners about these skills3-5. We hypothesized that a simulation-based medical education curriculum using RCDP focusing on CRM principles would fill the void of experiential learning and improve pediatrics resident confidence and competence in leading crisis scenarios
We created a simulation of a crisis on a pediatric ward which requires interventions appropriate for the expected skill set of a pediatrics resident. We previously developed and externally validated a task list with high internal consistency emphasizing CRM principles as the expected interventions. The scenario is divided into 3 stages with a total of 25 tasks: 6 in stage 1, 13 in stage 2, and 6 in stage 3. Stage 1 involves the care of an unresponsive patient by a pediatrics intern. In stage 2, the senior resident arrives and the patient subsequently develops status epilepticus. In stage 3, the simulated patient develops acute respiratory failure. The scenario ends with the arrival of the rapid response team. The residents participated in the simulated scenario in groups of 6. We debriefed using RCDP with the task list as a guide. Each stage encompassed 5 rounds of RCDP. We measured performance of each group in a simulated scenario prior to, and immediately following, the curriculum
Thirty-eight residents have completed the curriculum. Following participation, resident physicians showed improvement in mean task completion from 17% to 87% (p<0.001), with each individual resident group showing improvement. Additionally, there was improvement in task completion in each individual stage with stage 1 having mean task completion improvement from 24% to 95%, stage 2 with 20% to 81% mean task completion improvement, and stage 3 with 5% to 90% mean task completion improvement (p<0.001 for all stages). All respondents reported improved confidence in being team leader, being the first responder to a crisis, and in evaluation of a sick patient
This simulation-based medical education curriculum universally improved pediatric resident confidence in responding to, triaging, and leading a crisis scenario. Focusing on CRM principles directly addressed the specific needs of our pediatric resident physicians. RCDP debriefing allowed for rapid acquisition of CRM skills with all residents demonstrating significant improvement in CRM-focused task completion immediately following the curriculum. This proof of concept allows for further investigation of this simulation-based medical education curriculum which will focus on retention of skills and application to broader crisis scenarios.