Introduction Pediatrics is a unique field where the majority of the patient population is healthy....
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Introduction Pediatrics is a unique field where the majority of the patient population is healthy. Even though Cardiopulmonary arrests are relatively uncommon in children, [1] pediatric residents need to acquire the knowledge and skills necessary to perform emergency resuscitation of acutely ill children to improve the outcome for these patients. Pediatric Residency formal curriculum includes Pediatric Advance Life Support (PALS) training [2] and in the past 2 decades some hospitals have included Pediatric mock code as a way to expose the residents to the high stress scenario of real codes. [3] Studies have shown that video recordings of trauma resuscitations help identify weaknesses in the management, may improve the outcome of a code [3][4] and suggest that receiving feedback about the performance may improve competence [16] . At Driscoll children’s Hospital, mock codes have been conducted almost monthly since February 2010. The On call pediatric resident team runs the code, which is videotaped, and the activity is followed by a debriefing session with review of the recording led by the supervising Intensivist. Effect of Monthly Mock Codes on Pediatric Resident Education Principal Investigators: Maria Victoria Rodriguez, MD*. Jyotsna Kuppannagari,MD*.Dolores Medina Carbonell, MD**. Co-Investigator/Advisor: Kevin Schooler, M.D., Ph.D. Driscoll Children’s Hospital *Resident level III, Resident Level II** Abstract Objectives: To assess the effect of participation in monthly mock codes and their subsequent debriefings as an educational intervention for pediatric residents at Driscoll Children’s Hospital. Specifically, to determine the impact on improving resident’s knowledge and skills regarding code management. Methods: A prospective and retrospective, observational and non clinical study was done. 19 mock codes performed between February 2010 and March 2013 were observed. Residents’ competence was assessed with a predetermined check list. Residents’ confidence was evaluated by a questionnaire given to current Driscoll pediatric residents in March 2013. Results: Objectively, there was no particular trend of improvement seen in the total scores of mock codes. A large variability in task completion throughout mock codes was evident. The confidence of residents at running codes increased significantly as they advanced in training (p<0.0001) and it was highly evident and statistically significant in the 3rd year residents. Conclusions: The experience of residents running the code is a variable that affects the total outcome of a mock code. The inconsistency found in certain task completion provides ample opportunities for educational improvement in code management. The increase in subjective confidence of residents at managing codes may be attributed to their experience in mock codes but there may be other confounding factors. Description of study Conclusions • The experience of residents running the code is a variable that affects the total outcome of a mock code. • While this study follows only the resident’s performance at codes, it was observed that the nursing staff also plays a significant role in managing a code and their experience influences the outcome as well. • The inconsistency found in certain task completion provides ample opportunities for educational improvement in code management. • The increase in subjective confidence of residents at managing codes may be attributed to their experience in mock codes and subsequent debriefing session. However, there may be other contributing factors such as gaining more experience with patients, increasing fund of knowledge, doing PICU rotations and becoming more familiar with the hospital system. • Higher confidence levels was evident only in 3 rd year and not in 2 nd year residents possibly due to the latter’s lower participation in mock codes due to their assigned rotations during that year. References 1. Schaick SM, Von Kohorn I, O’sullivan P. Pediatric resident confidence in resuscitation skills relates to mock code experience. Clinical Pediatrics October 2008;47:777-783. 2. Andreatta P, Saxton E, Thompson M, Annich G. Simulation- based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Critical Care med 2011;12:33-39. 3. Hunt EA, Walker AR, Shaffner D H, Miller MR, Pronovost PJ. Simulation of In-Hospital Pediatric Emergencies and Cardiopulmonary Arrest: Highlighting the Importance of the first 5 minutes. Pediatrics 2008; 121:e34-e43. 4. Nadel FM, Lavelle JM, Fein JA, Giardino AP, Decker JM, Durbin DR. Teaching resuscitation to pediatric residents: The effects of an intervention. Arch Pediatr Adolesc Med, Vol 154, Oct 2000. 5. Marteau TM, Wynne G, Kaye W, Evans TR. Resuscitation: experience without feedback increases confidence but not skill. BMJ, volume 300, 31 March 1990, 849-50. 2013 Texas Pediatric Society Electronic Poster Contest Prospective and retrospective observational and nonclinical in nature study. Inclusion criteria: 1 st, 2 nd and 3 rd year Pediatric residents at Driscoll children's Hospital (Informed written consent obtained). Objective assessment: Participants were subjected to evaluation during mock code participation using a predetermined checklist based on PALS algorithms and widely accepted management criteria [standard of care]. (assessment of video recording of mock code). Subjective assessment: Current Residents’ confidence was evaluated in March 2013, using a questionnairre. • Objective evaluation: Resident competence There was no particular trend of improvement seen in the total scores of mock codes. A large variability in task completion throughout mock codes was evident. Notably, ABC management and following of PALS algorithm were performed consistently. • Subjective evaluation: Resident Confidence Subjective confidence of residents at running codes increased significantly as they advanced in training. Increase in confidence was highly evident and statistically significant only in 3rd year resident. Figure 1. Graph of percentage of task completion in the overall evaluation of the Mock codes. Some Tasks were consistently performed in most of the codes; others were not performed consistently giving ample opportunities for educational improvement. Figure 2. Graph of months in which mock code was evaluated and total score obtained. Total score is derived from the pre-determined check list (not shown) with a maximal value of 12. The higher value indicates better performance . Results Figure 3. Graph of subjective evaluation of Residents’ confidence in the different levels of training. The confidence increased as the residents advanced in training years and are exposed to more Mock codes during training. Figure 4. Graph comparing the confidence between 1st, 2 nd , 3 rd Pediatric Residents. The confidence increased 3 rd years was statistically significant.
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Transcript of Introduction Pediatrics is a unique field where the majority of the patient population is healthy....
Introduction
Pediatrics is a unique field where the majority of the patient population is healthy. Even though Cardiopulmonary arrests are relatively uncommon in children,[1] pediatric residents need to acquire the knowledge and skills necessary to perform emergency resuscitation of acutely ill children to improve the outcome for these patients. Pediatric Residency formal curriculum includes Pediatric Advance Life Support (PALS) training[2] and in the past 2 decades some hospitals have included Pediatric mock code as a way to expose the residents to the high stress scenario of real codes.[3]
Studies have shown that video recordings of trauma resuscitations help identify weaknesses in the management, may improve the outcome of a code[3][4]and suggest that receiving feedback about the performance may improve competence[16].At Driscoll children’s Hospital, mock codes have been conducted almost monthly since February 2010. The On call pediatric resident team runs the code, which is videotaped, and the activity is followed by a debriefing session with review of the recording led by the supervising Intensivist.
Effect of Monthly Mock Codes on Pediatric Resident Education
Principal Investigators: Maria Victoria Rodriguez, MD*. Jyotsna Kuppannagari,MD*.Dolores Medina Carbonell, MD**.
Co-Investigator/Advisor: Kevin Schooler, M.D., Ph.D. Driscoll Children’s Hospital *Resident level III, Resident Level II**
AbstractObjectives: To assess the effect of participation in monthly mock codes and their subsequent debriefings as an educational intervention for pediatric residents at Driscoll Children’s Hospital. Specifically, to determine the impact on improving resident’s knowledge and skills regarding code management.Methods: A prospective and retrospective, observational and non clinical study was done. 19 mock codes performed between February 2010 and March 2013 were observed. Residents’ competence was assessed with a predetermined check list. Residents’ confidence was evaluated by a questionnaire given to current Driscoll pediatric residents in March 2013. Results:Objectively, there was no particular trend of improvement seen in the total scores of mock codes. A large variability in task completion throughout mock codes was evident. The confidence of residents at running codes increased significantly as they advanced in training (p<0.0001) and it was highly evident and statistically significant in the 3rd year residents. Conclusions: The experience of residents running the code is a variable that affects the total outcome of a mock code. The inconsistency found in certain task completion provides ample opportunities for educational improvement in code management. The increase in subjective confidence of residents at managing codes may be attributed to their experience in mock codes but there may be other confounding factors.
Description of study
Conclusions• The experience of residents running the code is a
variable that affects the total outcome of a mock code.
• While this study follows only the resident’s performance at codes, it was observed that the nursing staff also plays a significant role in managing a code and their experience influences the outcome as well.
• The inconsistency found in certain task completion provides ample opportunities for educational improvement in code management.
• The increase in subjective confidence of residents at managing codes may be attributed to their experience in mock codes and subsequent debriefing session. However, there may be other contributing factors such as gaining more experience with patients, increasing fund of knowledge, doing PICU rotations and becoming more familiar with the hospital system.
• Higher confidence levels was evident only in 3rd year and not in 2nd year residents possibly due to the latter’s lower participation in mock codes due to their assigned rotations during that year. References
1. Schaick SM, Von Kohorn I, O’sullivan P. Pediatric resident confidence in resuscitation skills relates to mock code experience. Clinical Pediatrics October 2008;47:777-783.
2. Andreatta P, Saxton E, Thompson M, Annich G. Simulation- based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Critical Care med 2011;12:33-39.
3. Hunt EA, Walker AR, Shaffner D H, Miller MR, Pronovost PJ. Simulation of In-Hospital Pediatric Emergencies and Cardiopulmonary Arrest: Highlighting the Importance of the first 5 minutes. Pediatrics 2008; 121:e34-e43.
4. Nadel FM, Lavelle JM, Fein JA, Giardino AP, Decker JM, Durbin DR. Teaching resuscitation to pediatric residents: The effects of an intervention. Arch Pediatr Adolesc Med, Vol 154, Oct 2000.
5. Marteau TM, Wynne G, Kaye W, Evans TR. Resuscitation: experience without feedback increases confidence but not skill. BMJ, volume 300, 31 March 1990, 849-50. 2013 Texas Pediatric Society Electronic Poster Contest
Prospective and retrospective observational and nonclinical in nature study.
Inclusion criteria: 1st, 2nd and 3rd year Pediatric residents at Driscoll children's Hospital (Informed written consent obtained).
Objective assessment: Participants were subjected to evaluation during mock code participation using a predetermined checklist based on PALS algorithms and widely accepted management criteria [standard of care]. (assessment of video recording of mock code). Subjective assessment:Current Residents’ confidence was evaluated in March 2013, using a questionnairre.
• Objective evaluation: Resident competence
There was no particular trend of improvement seen in the total scores of mock codes.
A large variability in task completion throughout mock codes was evident.
Notably, ABC management and following of PALS algorithm were performed consistently.
• Subjective evaluation: Resident Confidence
Subjective confidence of residents at running codes increased significantly as they advanced in training.
Increase in confidence was highly evident and statistically significant only in 3rd year resident.
Figure 1. Graph of percentage of task completion in the overall evaluation of the Mock codes. Some Tasks were consistently performed in most of the codes; others were not performed consistently giving ample opportunities for educational improvement.
Figure 2. Graph of months in which mock code was evaluated and total score obtained. Total score is derived from the pre-determined check list (not shown) with a maximal value of 12. The higher value indicates better performance .
Results
Figure 3. Graph of subjective evaluation of Residents’ confidence in the different levels of training. The confidence increased as the residents advanced in training years and are exposed to more Mock codes during training.
Figure 4. Graph comparing the confidence between 1st, 2nd, 3rd Pediatric Residents. The confidence increased 3rd years was statistically significant.
