Assessing Simulation in Pediatrics: Improving Resuscitation Education

Examining Pediatric Resuscitation Education using

Simulation and Scripting (EXPRESS): A Multicenter Trial

Adam Cheng, Elizabeth Hunt, Aaron Donoghue, Kristen

Nelson, Walter Eppich, Vinay Nadkarni for the EXPRESS

Investigators

• Research Grant Support– American Heart Association – EXPRESS project– Laerdal Foundation for Acute Medicine– Heart and Stroke Foundation of Canada– Canadian Institute for Health Research

• Intellectual– Pediatric Subcommittee, American Heart Association– Contributing Editor, 2011 PALS Instructor Manual

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Disclosure

• Trend:– More simulation in

standardized resuscitation courses (PALS, ACLS)

• Issue: – Thousands of instructors

across North America– Instructor debriefing skills

are variable

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Background

• Proposed Solution: Debriefing Script– Sound debriefing principles– Framework– Specific wording and phrases– Promotes reflective learning

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Debriefing Script

Multicenter Study• Prospective, RCT• Factorial design• Subjects:

– Novice Instructors– Interprofessional

pediatric healthcare teams

Assessing Simulation in Pediatrics: Improving Resuscitation Education

EXPRESS Study

Low Realism (LoR)

High Realism (HiR)

Non-Scripted Debriefing (nS)

nS - LoR nS - HiR

Scripted Debriefing (S)

S - LoR S - HiR

Assessing Simulation in Pediatrics: Improving Resuscitation Education

EXPRESS Study

Institution Investigator(s)BC Children’s Hospital Adam Cheng

Children’s Hospital of Philadelphia Vinay Nadkarni, Aaron Donoghue, Akira Nishisaki

Johns Hopkins Betsy Hunt, Kristen Nelson

Children’s Medical Center Dallas Judy Leflore, Jeffrey Hopkins

Cincinnati Children’s Mike Moyer, Mary Patterson

Children’s Memorial Hospital Walter Eppich, Mark Adler

Children’s Hospital Boston Marisa Brett-Fleegler, Monica Kleinman, Liana Kappus

Children’s Hospital at Dartmouth Matthew Braga

AI Dupont Susanne Kost, Glen Stryjewski

Walter Reed / National Naval Steve Min, John Podraza, Joe Lopreiato

Pittsburgh Children’s Melinda Fiedor-Hamilton

Stollery Children’s Hospital Jonathan Duff

Center for Medical Simulation Robert Simon, Jenny Rudolph

Seattle Children’s Hospital Kimberly Stone, Jennifer Reid

Oregon Health Sciences JoDee Anderson

• Task-based guidance

• Performed Well vs. Needs Work

• Debriefing Theory: Advocacy Inquiry

Assessing Simulation in Pediatrics: Improving Resuscitation Education

EXPRESS Script

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Debriefing Script

Assessing Simulation in Pediatrics: Improving Resuscitation Education

EXPRESS – Study Design

Interprofessional TeamInterprofessional Team

Outcome Measures- Knowledge- Behavioural Performance

- Cognitive Performance

Outcome Measures- Knowledge- Behavioural Performance

- Cognitive Performance

Simulation Scenario - PRESimulation Scenario - PRE

Simulation Scenario - POSTSimulation Scenario - POSTSimulation Scenario - POSTSimulation Scenario - POST

Non-Scripted DebriefingNon-Scripted DebriefingScripted DebriefingScripted Debriefing

Simulation Scenario - PRESimulation Scenario - PRE

n=200n=187

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Review Team

Cognitive Performance Tool (CPT)

Behavioural Assessment Tool (BAT)

Debriefing Assessment for Simulation in Healthcare (DASH)

Stephanie Sudikoff

Frank Overly

Marino Festa

Takanari Ikeyama

John Podraza

Glenn Stryjewski

Aaron Donoghue

Matthew Braga

Kathleen Ventre

Jonathan Duff

Douglas Leonard

Kristine Boyle

Laura Corbin

Mike Moyer

JoDee Anderson

Jeffrey Hopkins

Walter Eppich

Vinay Nadkarni

Akira Nishisaki

Elizabeth Hunt

Kristen Nelson

Monica Kleinman

Marisa Brett-Fleegler

Adam Cheng

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Research Portal

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Research Portal

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Research Portal

Functionality LMS Res Portal

SecurityCustom admin access Y Y

Study DesignCustom study design – arm / group / subject hierarchyAutomated or custom assignment of subject codes

NN

YY

Assessment ToolsCustom tool creationMatch assessment tools to videos

YY

YY

Video ManagementUpload of video from multiple sites with different A/V systemsCustom assignment of video to team OR individuals based on study armView review and data entry online from multiple sites

YNN

YYY

Data ManagementDownload custom spreadsheets according to study arm or outcome measure

N Y

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Results

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Validation of Assessment Tools

Assessing Simulation in Pediatrics: Improving Resuscitation Education

EXPRESS Results

Why weren’t our results more significant?

Scripted Debriefing:•One scenario – Difficulty? Enough exposure?•Length of debriefing

Realism•High emotional, conceptual and environmental realism•Enough exposure?

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Limitations

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Research Process

AHA Pediatric Subcommittee identified:•Existing PALS instructor material were inadequate•More debriefing instruction and guidance was required•Standardized method of debriefing needed to be introduced

Assessing Simulation in Pediatrics: Improving Resuscitation Education

PALS Instructor Training

• Online debriefing module

• GAS Model– Gather– Analyze– Summarize

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Structured and Supported Debriefing

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Challenge

Assessing Simulation in Pediatrics: Improving Resuscitation Education

What worked… and What Didn’t

EXPRESS Debriefing Script:

Assessing Simulation in Pediatrics: Improving Resuscitation Education

New Debriefing Tool

Assessing Simulation in Pediatrics: Improving Resuscitation Education

New Debriefing Tool

Assessing Simulation in Pediatrics: Improving Resuscitation Education

New Debriefing Tool

Assessing Simulation in Pediatrics: Improving Resuscitation Education

New Debriefing Tool

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Pilot Testing

• Structured and Supported Debriefing• Instructor Course• Instructor Manual

– New debriefing chapter– Scenario Cards

• Front : Scenario• Back : Debriefing Tool

Assessing Simulation in Pediatrics: Improving Resuscitation Education

2011 PALS Instructor Training

Assessing Simulation in Pediatrics: Improving Resuscitation Education

PALS Scenario Cards

Assessing Simulation in Pediatrics: Improving Resuscitation Education

ACLS Scenario Cards

Assessing Simulation in Pediatrics: Improving Resuscitation Education

PALS Debriefing

• Scripted debriefing helps to improve learning outcomes

• Knowledge acquired from simulation-based research can be disseminated via collaboration with established associations

• Future Directions– Research : instructor and learner feedback, compliance,

usability, learner outcomes, patient outcomes– Use of debriefing tool in non-PALS context

Effective knowledge translation = Greater Impact

Assessing Simulation in Pediatrics: Improving Resuscitation Education

Take Home Messages

Assessing Simulation in Pediatrics: Improving Resuscitation Education

INSPIRE Network

• Attend meetings / webinars

• Research– Single site studies– Multicenter studies

• Primary or site investigator

• Video reviewer• Consultant

Assessing Simulation in Pediatrics: Improving Resuscitation Education

INSPIRE Network

• Distribution List: – Nicola Robertson –

nicola.robertson@albertahealthservices.ca

• Research:– Adam Cheng ch

enger@me.com– Marc Auerbach

dr.auerbach@gmail.com