Does Simulation Improve Recognition and Management of Pediatric Septic Shock, and If One Simulation Is Good, Is More Simulation Better?*.
Dugan, Mark C. MD; McCracken, Courtney E. PhD; Hebbar, Kiran B. MD, FCCM
Pediatric Critical Care Medicine.
17(7):605-614, July 2016.
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Objectives: Determine whether serial simulation training sessions improve resident recognition and initial septic shock management in a critically ill simulated septic shock patient, and to determine whether serial simulations further improve resident task performance when compared with a single simulation session.
Design: Prospective observational cohort study with a live expert review of trainee simulation performance. Expert reviewers blinded to prior trainee performance.
Setting: A PICU room in a quaternary-care children's hospital, featuring a hi-fidelity pediatric patient simulator.
Subjects: Postgraduate year-2 and postgraduate year-3 pediatric residents who rotate through the PICU.
Interventions: Postgraduate year-3 residents as the control cohort, completing one simulation near the start of their third residency year. Postgraduate year-2 residents as the intervention cohort, completing two simulations during their second residency year and one near the start of their third residency year.
Measurements and Main Results: Resident objective performance was measured using a validated 27-item checklist (graded 0/1) related to monitoring, data gathering, and interventions in the diagnosis and management of pediatric septic shock. The intervention cohort had a higher mean performance percentage score during their third simulation than the control cohort completing their single simulation (87% vs 77%; p < 0.001). Septic shock was correctly diagnosed more often in the intervention cohort at the time of their third simulation (100% vs 78%; p < 0.001). Appropriate broad-spectrum antibiotics were administered correctly more often in the intervention cohort (83% vs 50%; p < 0.001).
Conclusions: Simulations significantly improved resident performance scores in the management of septic shock with repetitive simulation showing significant ongoing improvements. Further studies are needed to determine long-term impact on knowledge and skill retention and whether results attained in a simulation environment are translatable into clinical practice in improving bedside care.
(C)2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies