How COVID-19 Taught Us to Address Self-identified Learning Gaps: A Simulation Based Approach

Background: The COVID-19 pandemic presented a variety of challenges to learners at all levels of training. The fall and winter seasons are when Pediatric trainees are exposed to a high volume of respiratory illnesses such as bronchiolitis, croup and asthma. However the advent of social distancing and use of face masks showed a significant decrease in the burden of infectious diseases. A multi-center study using the Pediatric Health Information System (PHIS) showed that ED visit rates decreased by 45.7% during the pandemic as compared to the three years prior(1). At our institution we saw a 90% reduction in bronchiolitis cases after the stay-at-home order went into effect March 30, 2020 compared to 2019 data for the same time period. With less hands-on experience, trainees are struggling to identify, triage and manage respiratory distress.

Methods: Given the missed learning opportunities associated with COVID-19 and a low volume respiratory season, interns requested an expansion of the simulation curriculum to include specific content review for respiratory distress. The session started with a brief fifteen minute overview in the Just-in-Time-Teaching (JiTT) style(2). Learning objectives included recognizing the signs and symptoms of respiratory distress, reviewing the differential diagnoses, initiating treatment for the various differentials and escalating care in a timely fashion. Interns then moved on to the simulated cases. We used a high-fidelity baby mannequin for a bronchiolitis case and pediatric mannequin for an asthma case. Cases were debriefed in the Advocacy-Inquiry Method and interns were asked to share one piece of practice changing knowledge.

Results: Interns (n=17) were anonymously surveyed before and after the session with responses measured on the 5-point Likert scale(3). 80% of interns reported that the COVID-19 pandemic impacted their medical education and, following the completion of cases, 94% strongly agreed that simulations were a helpful way to supplement their medical training. Two interns completed a post-survey but did not complete a pre-survey.

Before the simulation, 13% of interns reported not feeling adequately prepared to identify respiratory distress and only 6% felt adequately prepared to manage it. After the simulation, 82% of interns felt adequately prepared to identify respiratory distress and 82% felt prepared to manage it.

Conclusion: Public health mandates during the COVID-19 pandemic proved effective for controlling disease spread, but created a knowledge gap for Pediatric trainees regarding commonly encountered respiratory diseases. We addressed this gap in real time by modifying our simulation curriculum to include a content review of respiratory distress. Interns showed improved self-reported confidence in their diagnostic and treatment abilities. Continued use of JiTT in the simulation setting could be a helpful way to bridge resident-identified knowledge gaps on a more routine basis. Further work needs to be done to establish the long-term effectiveness of this flexible, learner-specific curriculum.