PCICU attending; Director, Pediatric MCS, Pulmonary hypertension; heart failure attending Advocate Children's Heart Institute/University of Chicago Comer Children's Valparaiso, Indiana, United States
Abstract:
Introduction: Simulation boot camps have become a common component of pediatric critical care and cardiology curricula, especially for first-year trainees. These camps deliver rapid knowledge acquisition combined with training in technical, teamwork, and leadership skills. To provide an emphasis on pediatric cardiac intensive care (PCIC), we developed an advanced PCIC multi-program boot camp for pediatric ICU and cardiology fellows focused on collaboration and education during simulated cardiac emergencies. The limitation placed on in-person attendance caused by the COVID pandemic prompted the additional development of a virtual PCIC boot camp. We aimed to determine if our in-person and virtual boot camps were feasible and provided similar educational experiences.
Methods: A team of simulation, PCICU, and general PICU content experts created multi-modality simulations and skill stations related to pediatric cardiac emergencies for simulation boot camps involving multiple simultaneous learners. Separate virtual and in-person camps were developed with simulations and skills for pediatric ICU and cardiology fellows from local programs (in-person camp: IPC) for a 2-day camp and non-local programs (virtual camp: VC) for a 1-day camp, held one week apart. Demographic, pre-and post-test surveys were disseminated online.
Results: 30 fellows participated (PICU 23, cardiology 7). In the VC, there were 13 fellows from 4 programs, while in the IPC, 17 fellows from 3 programs. There were 17 simulations for the IPC, compared to 11 for the VC, with two skills stations and cognitive case discussion sessions for both camps. Simulations included acquired and congenital heart disease complications, including stroke and hemorrhage, as well ECMO and ventricular assist device (VAD) therapies. Prior to camp, 82% (14/17) of IPC learners responded to surveys: 71% did not have knowledge of VAD management; 67% were unaware of how to manage stroke on a cardiac ECMO patient; 43% were not confident initiating management for an arrhythmia and 50% had never led a cardiac arrest (3 PICU and 4 cardiology fellows). Prior to camp, 100% (13/13) of VC learners responded: 50% did not have knowledge of management of absent aortic valve opening on a cardiac ECMO patient; 42% were not confident initiating management for an arrhythmia and 18% had never led a cardiopulmonary resuscitation with only 27% of those who had led feeling confident doing so. Following camp, VC and IPC learners were ‘satisfied’ or ‘very satisfied’ (100%), reporting gain of new knowledge and skills, with 93% able to initiate management for stroke for cardiac patients on ECMO, VAD and those not on mechanical support and 100% able to initiate management for atrial arrhythmia. Confidence in leading emergencies improved for both VC and IPC learners (77% and 79%, respectively).
Conclusions: Virtual and in-person pediatric cardiac-specific simulation boot camps are feasible and well-received by learners. Given variability of learner experience, work force restrictions, financial limitations and an ongoing pandemic, development of innovative multiprogram educational strategies allows trainees to collaborate and gain confidence while learning and practicing skills critical to management of cardiac emergencies.
