Cumulative evaluation data: pediatric airway management simulation courses for pediatric residents

Alyousef et al. Advances in Simulation (2017) 2:11 DOI 10.1186/s41077-017-0044-3 INNOVATION Open Access Cumulative evaluation data: pediatric airway management simulation courses for pediatric residents Sawsan Alyousef1,2*, Haifa Marwa1, Najd Alnojaidi4, Hani Lababidi2 and Muhammad Salman Bashir3 Abstract Objectives: To utilize cumulative evaluation data of the pediatric airway management simulation-based learning course on knowledge and practical skills of residents in the Saudi Commission for Health Speciality (SCFHS) in order to measure its efficacy and areas for improvement. Methods: The evaluation is a retrospective cohort study that compares pre- and post-test (knowledge and skills) of a pediatric airway management simulation course. The 2-day course has been conducted four times annually at CRESENT and is comprised of interactive lectures on airway management and crew resource management, a demonstration of fundamentals of intubation, three skill stations, and six case scenarios with debriefing. Our evaluation data includes all pediatric residents who attended the course between January and December 2015. Results: Forty-six residents participated, of whom 30 (65.2%) are male and 16 (34.78%) are female. Overall, there is statistically significant improvement between the pre-test and post-test knowledge and practical skill scores. The pre-test scores are significantly different between the four different resident levels with p values of 0.003 and <0.001 respectively. However, there are no statistically significant differences in the post-test scores among the four different resident levels with p values of 0.372 and 0.133 respectively. The practical skill assessment covers four main domains. Improvements were noted in pharmacology (811%), equipment setup (250%), intubation steps (200%), and patient positioning (130%). The post-test scores are similar in all practical skill categories for the four different residency levels. Discussion: Our outcome-based evaluation strategy demonstrated that residents met the course learning objectives. The pediatric airway management simulation course at CRESENT is effective in improving the knowledge and practical skills of pediatric residents. Although the greatest improvement is noted among junior residents, learners from different residency levels have comparable knowledge and practical skills at the end of the course. Things that can be improved based on our study results include stressing more the type and dosages of the medications used in airway management and mandating the course for all junior pediatric residents. Although residents scored well, specific knowledge and skill elements still led us to targeted areas for course excellence. Similar courses need to be integrated in the pediatric residency curriculum. Further research is needed to study skill retention and more importantly its impact on patients’ care. Although resource-intensive, the use of cumulative evaluation data helped to focus quality improvement in our courses. * Correspondence: 1 Specialized Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia 2 Center for Research, Education & Simulation Enhanced Training (CRESENT), King Fahad Medical City, Riyadh, Saudi Arabia Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Alyousef et al. Advances in Simulation (2017) 2:11 Page 2 of 6 Introduction Airway management is a common procedure performed in the Pediatric Intensive Care Unit (PICU) and Emergency Department (ED). In contrast to the clinical experience with elective intubation in the operating room, intubation of critically ill patients has been associated with several complications [1]. Most airway management situations in the PICU/ED are emergent, leaving providers with limited time to perform a systematic airway assessment. Critically ill patients frequently have significant cardiac and pulmonary disease and limited physiologic reserve [2, 3]. These complicating factors commonly result in significant preoxygenation difficulty, limitations in the choice and dose of commonly used induction and paralytic agents, and less time for intubation preparation and performance. Loss of muscle tone, secretions and upper airway edema also increase the technical difficulty of glottis visualization and successful procedure performance [4, 5]. The number of intubation attempts increases the risk of adverse tracheal intubation associated events such as severe hypoxia, hypotension and cardiac arrest [2, 6, 7]. It also increases the risk of intraventricular hemorrhage in low birth weight neonates [8]. The pediatric airway management simulation course is conducted four times per year at CRESENT, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. The course was adapted from the American College of Chest Physicians (ACCP). The course has been selected by pediatric residents at KFMC in the top five most common simulation courses needed. We wanted to utilize cumulative evaluation data of the pediatric airway management simulation-based learning course on knowledge and practical skills of residents in the Saudi Commission for Health Speciality (SCFHS) in order to measure its efficacy and areas for improvement. with an instructor to resident ratio of 1:6. Learning objectives are listed in Table 1. During the introduction, the course director introduces the instructors and simulation technicians. The course director and instructors are all pediatric intensivists with experience in simulation-based education including targeted training on using simulation to support learning. The faculty has participated in faculty development courses at CRESENT, namely the FD-Sim course, and IMS course from the Center of Medical Simulation (CMS). The residents tour the simulation center and are familiarized with the simulation rooms, debriefing rooms, simulators and all the equipment. The course director introduces the basic assumption and safety container [12]. The simulation rooms resemble PICU rooms and equipped with SimJunior® or SimBaby®, crash cart with a defibrillator and airway tools for infants and children. The course utilizes three skills station rooms: 1) basic airway tools and infant and child intubation heads (Fig. 1), 2) advanced airway tools such as video laryngoscope and intubation bronchoscope and 3) surgical airway tools for cricothyroi (...truncated)