Implementation of an Institutional Simulation Curriculum to Teach Team Leadership Skills, Management of Critically Ill Patients, and Emergent Procedures to Pediatric Residents

Background: Simulation in medical training is effective at increasing clinical knowledge, improving comfort with procedures, and teaching crisis resource management skills. Uniquely, simulation can also expose trainees to standardized cases independent of available clinical experience. This is especially important at a time when the COVID-19 pandemic has paradoxically led to decreased emergency department visits and hospitalizations, and, consequentially, decreased clinical opportunities for trainees. We developed and piloted a formal, longitudinal, high-fidelity simulation curriculum for pediatric residents, led by pediatric emergency medicine fellows in a unique, near-peer training program. The project goal was to assess the efficacy of this curriculum at increasing resident self-reported comfort in leading a team, managing critically ill patients, and performing essential emergent procedures.

Methods: Six cases were designed by pediatric residents and emergency medicine fellows for the curriculum. Cases were reviewed by faculty members, focused on a critically ill pediatric patient, and included an associated emergent procedure. Three of the cases were used for the study, which was conducted over a four-month period in the 2021 academic year. Study participation was voluntary, and 27 pediatric residents participated, completing up to three cases each. Data was collected as self-reported Likert scales for questions regarding leadership, individual medical knowledge, and comfort with procedures. Surveys were completed prior to the curriculum implementation, following each case, and at study conclusion. To account for expected improvements during traditional residency training, data was also collected for two control cases not used in the study. Wilcoxon Signed-Rank test was used to compare pre- and post-intervention assessments. For significant results, the Dwass-Steel-Chritchlow-Fligner method was used to examine pair-wise comparisons by trainee post-graduate year.

Results: Results are summarized in Table 1 and Table 2. There was a significant improvement in self-reported ability to function as team leader, identify and designate roles, effectively organize and minimize noise in the room, effectively use closed loop communication, and access additional resources. There was also an increase in self-reported comfort level with both medical knowledge and performing emergent procedures. There was no significant difference between responses based on trainee year. As expected, residents also reported an improvement in medical knowledge about control cases, although the improvement was less than with the implemented cases. When the size of this effect was compared between implemented and control cases, there was a trend towards significance favoring the simulated cases, suggesting that statistical significance may be achieved with a larger sample size.

Conclusion: The implementation of a simulation curriculum can lead to improvements in pediatric resident’s self-reported comfort with crisis resource management, team leadership, clinical knowledge, and emergent procedures. The effect on medical knowledge and comfort with procedures may be significantly different than the gains expected naturally over time in pediatric residency training.