Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents

Abstract

Background Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes. Objective To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE. Methods Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE. Results No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n = 30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention. Conclusions A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols.

Residents' Procedural Experience Does Not Ensure Competence: A Research Synthesis

“…For instance, gastroenterology fellows who practiced on a colonoscopy simulator rather than patients performed as well during actual patient colonoscopies as fellows who had already performed 80 procedures on actual patients. 7 Simulation-based mastery learning has been used to improve skills in diverse clinical areas, including endof-life discussions, 28 cardiac auscultation, 29 management of pediatric status epilepticus, 30 advanced cardiac life support, 18 and laparoscopic surgery, 31 and has also been shown to reduce patient complications, 12,14,[32][33][34] decrease length of hospital stay, 33 and reduce hospital costs. 35,36 This study has several limitations.…”

Implementation of LURIES: A New Handoff Tool for Pediatric Residents

“…The concept of self-efficacy was first described in the 1970s as an individual’s belief in her capability to organize and execute a plan to manage future situations [ 7 ]. Self-efficacy predicts academic performance in medical students [ 7 ] and is correlated with resident performance in simulated patient care scenarios [ 8 ]. While self-efficacy levels are not without limitations in correlating to performance [ 9 , 10 ], use of LURIES increased the resident perception of self-efficacy and comfort with patient management while caring for patients overnight, discussing management plans with parents and nursing staff, and anticipating acute events, leading to widespread use of the tool.…”

Simulation in Neurocritical Care: Past, Present, and Future

“…Brain death determination simulations have also raised awareness regarding the incompetence of many physicians who perform the determination. As a corollary, a study investigating mastery of status epilepticus management for pediatric residents found that prior to the intervention, none of the residents achieved satisfactory performance as measured by an observational checklist of required action items, but all met mastery standards following the intervention [85].…”