Can a High-fidelity Simulation Curriculum Decrease Mental Workload for Pediatric Residents? (1090-002263) (Developmental Research Projects: Sim Methods and Learning Theory (By Invitation Only))
Start time: Tuesday, February 2, 2021, 4:00 PM End time: Tuesday, February 2, 2021, 5:00 PM Session Type: Research Study Development and Presentation Program Abstracts
Pediatric code events occur less often than adult events leading to decreased code exposure for trainees1,2. Simulation can increase trainee exposure to crisis events in a risk-free setting and facilitate reflection while decreasing mental workload (MWL)3,4. MWL is the level of cognitive load that can directly impact learning and performance5. Heart rate variability (HRV) has been shown to be an effective tool for the objective evaluation of MWL and has been used with simulation outside of medicine5. Previous studies have shown that increased MWL leads to decreased performance in simulated scenarios7,8. Application of HRV in simulation-based medical education is lacking. The primary aim of our pilot study is to compare HRV as a surrogate for MWL in pediatric residents before and after participation in an acute care simulation curriculum. We hypothesize that MWL of learners will decrease and there will be an improvement in learner performance and confidence surrounding crisis events.
Our institution has developed a two-week dedicated acute care simulation curriculum for senior pediatrics residents. The curriculum consists of standardized crisis simulation scenarios and associated lectures on pediatric emergencies covering a broad range of pathophysiology with focus on American Board of Pediatrics content specifications. During simulation events, residents are equipped with heartrate monitors to record HRV data. HRV data is analyzed using frequency domain analysis where increased low frequency to high frequency (LF/HF) ratio indicates higher MWL. Resident simulation performance is recorded using the externally validated Simulation Team Assessment Tool (STAT). Learner comfort is assessed by pre- and post-curriculum surveys using a 5-point Likert Scale assessing learner confidence in performing 9 skills required in pediatric code and crisis scenarios including acting as a team leader, performing chest compression, and using a defibrillator.
In the fall of 2019, 7 residents participated in the curriculum. Four residents (57%) had decreased LF/HF ratio at the final simulation scenario compared to the first simulation suggesting lower MWL at end of curriculum. For these residents, the average decrease in LF/HF ratio was 33%. Six residents (86%) had improved simulation performance as evidenced by improved STAT scores. The mean STAT score improvement amongst all residents was 10%. Resident surveys demonstrated increased confidence in all nine tasks of interest. This pilot study is ongoing with eight residents participating in the curriculum twice a year and data will be collected for two more cycles.