Retention of Pediatric Resuscitation Performance After a Simulation-Based Mastery Learning Session

Braun, LoRanée; Sawyer, Taylor; Smith, Kathleen; Hsu, Angela; Behrens, Melinda; Chan, Debora S.; Hutchinson, Jeffrey; Lu, Downing; Singh, Raman Jeet; Reyes, Joel; Lopreiato, Joseph

doi:10.1097/pcc.0000000000000315

Cited by 41 publications

(43 citation statements)

References 17 publications

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“…Randomised controlled trials of newborn resuscitation training infrequently report clinical outcomes and a cluster randomised approach may be a more suitable trial design to assess these outcomes 1. It has been established that newborn resuscitation skills can deteriorate over time, therefore we cannot conclude that the improvement shown in this trial will be retained on a long-term basis 23 24. However, Schilleman et al demonstrated that a reduction in newborn mask leak immediately after training was maintained 3 weeks later 25.…”

Section: Discussionmentioning

confidence: 94%

Respiratory monitors to teach newborn facemask ventilation: a randomised trial

O’Curráin

Thió

Dawson

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveThe International Liaison Committee on Resuscitation has found that there is a need for high-quality randomised trials of training interventions that improve the effectiveness of resuscitation skills. The objective of this study was to determine whether using a respiratory function monitor (RFM) during mask ventilation training with a manikin reduces facemask leak.DesignStratified, parallel-group, randomised controlled trial. Outcome assessors were blinded to group allocation.SettingThirteen hospitals in Australia, including non-tertiary sites.ParticipantsConsecutive sample of healthcare professionals attending a structured newborn resuscitation training course.InterventionsAn RFM providing real-time, objective, leak, flow and volume information was attached to the facemask during 1.5 hours of newborn ventilation and simulation training using a manikin. Participants were randomised to have the RFM display visible (intervention) or masked (control), using a computer-generated randomisation sequence.Main outcome measuresThe primary outcome was facemask leak measured after neonatal facemask ventilation training. Tidal volume was an important secondary outcome measure.ResultsParticipants were recruited from May 2016 to November 2017. Of 402 eligible participants, two refused consent. Four hundred were randomised, 200 to each group, of whom 194 in each group underwent analysis. The median (IQR) facemask leak was 23% (8%–41%) in the RFM visible group compared with 35% (14%–67%) in the masked group, p<0.0001, difference (95% CI) in medians 12 (4 to 22).ConclusionsThe display of information from an RFM improved the effectiveness of newborn facemask ventilation training.Trial registration numberACTRN12616000542493, pre-results.

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Section: Discussionmentioning

confidence: 94%

Respiratory monitors to teach newborn facemask ventilation: a randomised trial

O’Curráin

Thió

Dawson

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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“…Similar studies of intensive simulation-based mastery learning have demonstrated skills retention up to 12–14 months among Internal Medicine residents,15 16 whereas shorter (1–2 hours) sessions among paediatric residents resulted in linear decline of performance, with 92% retention at 2 months and 56% at 6 months 17. While this curriculum was not designed as mastery training, we noted overall retention of improvements through the 4–6 month follow-up assessment, suggesting that shorter sessions among paediatric residents may retain greater efficacy than previously suggested.…”

Section: Discussionmentioning

confidence: 72%

Repetitive simulation is an effective instructional design within a pediatric resident simulation curriculum

2018

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IntroductionRepetitive paediatric simulation (scenario-debrief-scenario; RPS) is an instructional design that allows immediate application of learner-directed feedback, in contrast to standard simulation (scenario-debrief; STN). Our aim was to examine the impact of RPS embedded within a paediatric resident simulation curriculum, comparing it to STN.MethodsIn this prospective educational cohort study, paediatric residents were enrolled in STN (n=18) or RPS (n=15) groups from August 2012 through June 2013. Each group performed an initial high-fidelity simulation and another after 1–2 weeks. Attitudes, confidence and knowledge were assessed using anonymous surveys with each scenario and at 4–6 months. Skills were assessed in real time with a modified Tool for Resuscitation Assessment Using Computerised Simulation (TRACS). Two blinded reviewers assessed a subset of videotaped scenarios for TRACS inter-rater reliability.ResultsBoth STN and RPS designs were rated highly. The curriculum led to significant short-term and long-term improvements in confidence, knowledge and performance, with no significant differences between groups. All final respondents reported that they would prefer RPS to STN (n=6 STN, 4 RPS). TRACS intraclass correlation was 0.87 among all reviewers.ConclusionsPaediatric residents reported preference for RPS over STN, with comparable impacts on confidence, knowledge and performance. The modified TRACS was a reliable tool to assess individual resident performance. Further research is needed to determine whether RPS is a more effective instructional design for teaching resuscitation skills to paediatric residents.

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“…When evaluating the success of an educational intervention, the recognized confounder of skill decay must be considered. Skill and knowledge can quickly decay after simulation‐based education, with one study reporting decay as early as 2 weeks . Educational theory suggests the benefit of simulation stems from repetitive practice .…”

Section: Discussionmentioning

confidence: 99%

“…Educational theory suggests the benefit of simulation stems from repetitive practice . Yet even with repetition, skills and knowledge decay, Braun et al . demonstrated that learner performance declined at 2 months even with repetitive practice until “mastery‐level performance” was met.…”

Section: Discussionmentioning

confidence: 99%

A Mixed‐methods Comparison of Participant and Observer Learner Roles in Simulation Education

Bullard

Weekes

Cordle

et al. 2018

AEM Education and Training

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Background: Traditional simulation-based education prioritizes participation in simulated scenarios. The educational impact of observation in simulation-based education compared with participation remains uncertain. Our objective was to compare the performances of observers and participants in a standardized simulation scenario. Methods:We assessed learning differences between simulation-based scenario participation and observation using a convergent, parallel, quasi-experimental, mixed-methods study of 15 participants and 15 observers (N = 30). Fifteen first-year residents from six medical specialties were evaluated during a simulated scenario (cardiac arrest due to critical hyperkalemia). Evaluation included predefined critical actions and performance assessments. In the first exposure to the simulation scenario, participants and observers underwent a shared postevent debriefing with predetermined learning objectives. Three months later, a follow-up assessment using the same case scenario evaluated all 30 learners as participants. Wilcoxon signed rank and Wilcoxon rank sum tests were used to compare participants and observers at 3-month follow-up. In addition, we used case study methodology to explore the nature of learning for participants and observers. Data were triangulated using direct observations, reflective field notes, and a focus group.Results: Quantitative data analysis comparing the learners' first and second exposure to the investigation scenario demonstrated participants' time to calcium administration as the only statistically significant difference between participant and observer roles (316 seconds vs. 200 seconds, p = 0.0004). Qualitative analysis revealed that both participation and observation improved learning, debriefing was an important component to learning, and debriefing closed the learning gap between observers and participants.Conclusions: Participants and observers had similar performances in simulation-based learning in an isolated scenario of cardiac arrest due to hyperkalemia. Findings support current limited literature that observation should not be underestimated as an important opportunity to enhance simulation-based education. When paired with

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Retention of Pediatric Resuscitation Performance After a Simulation-Based Mastery Learning Session

Cited by 41 publications

References 17 publications

Respiratory monitors to teach newborn facemask ventilation: a randomised trial

Respiratory monitors to teach newborn facemask ventilation: a randomised trial

Repetitive simulation is an effective instructional design within a pediatric resident simulation curriculum

A Mixed‐methods Comparison of Participant and Observer Learner Roles in Simulation Education

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