Enhancing Situational Awareness and Patient Safety in Pediatrics Through Virtual Simulation

Background: Patient safety adverse events are a significant concern in pediatric healthcare in the US. Learning how to identify and report identified errors and near misses enables mitigation of current and future harm. An interactive in-person simulation activity at our institution has been successful in enhancing medical students and trainees’ ability to identify and report patient safety hazards. Infection prevention precautions during the COVID-19 pandemic necessitated the rapid development of a virtual simulation training in 2020-2021. Our objectives were to assess the feasibility and effectiveness of a virtual simulation training to enhance medical students and trainees’ awareness of and confidence in identifying and reporting patient safety hazards.

Methods: Learners were 102 second year medical students starting clinical clerkships. Brief orientation videos reviewed learning objectives, instructions on navigating the 360-video virtual interface, and the simulated case – a 5 y/o boy in the emergency department with an acute asthma exacerbation. Learners then explored a 360 video in a virtual simulation environment to identify hazards that fell into the broad themes of falls, allergies, protected health information, personal protective equipment, hand hygiene, choking, medication administration, privacy, electronic health records, and infections. Learners then viewed brief instructional videos on these hazards, the importance of situational awareness, and how to report near misses and errors using our hospital incident reporting system. Effectiveness and learners experience was assessed through pre and post simulation questionnaires and learner interviews.

Results: Key outcomes were frequency of safety issues identified and confidence in identifying and reporting hazards, errors and near misses. Scores of learner confidence in identifying and reporting patient safety hazards significantly increased (see Figure). Learners rated their overall satisfaction on a 0-10 scale (0= Not at all Satisfied, 10= Very Satisfied). Median learner satisfaction scores were 7. Learners reported that the virtual simulation was a good alternative to in-person training. Specific positive aspects identified were the short instructional videos with a variety of speakers, the concise nature of the activity, and learning to how to file incident reports. The increase in confidence in identifying and reporting patient safety hazards were lower in the virtual simulation compared to the in-person version. However, learners identified several strategies to enhance the experience in future years. Specific areas for improvement were zooming in capabilities on mobile devices and variation in experience depending on internet speed and device used.

Conclusion: This brief interactive simulation activity was successful in enhancing learners’ awareness of and confidence in identifying and reporting patient safety hazards. Our next steps include improving the immersive nature of the simulation experience, integrating more authentic components, replicating a team approach, and identifying platforms that are suited to a variety of mobile devices and internet speeds.