K. Sofia Mendieta
Monroe Carell Jr Children's Hospital at Vanderbilt
Nashville, Tennessee
Disclosure information not submitted.
Kelly Craighead, CPNP-AC
Nurse Practitioner
Monroe Carell Jr. Children's Hospital at Vanderbilt, Tennessee, United States
Disclosure information not submitted.
Isaura Diaz, MD
Associate Program Director, Pediatric Critical Care Fellowship Training Program
Monroe Carell Jr Childrens Hospital at Vanderbilt, Tennessee, United States
Disclosure information not submitted.
Title: Formal Simulation Education Use in the Pediatric Cardiac ICU
Introduction: Managing pediatric cardiac patients (PCP) involves understanding complex physiology. Data regarding pediatric critical care (PCC) fellows and cardiac simulation curriculum (CSC) is scarce. The primary goals of this study were to identify the number of PCC programs that have a CSC and to gauge learners’ confidence in managing PCP. We implemented a CSC for PCC fellows and advanced practice providers (APPs) at our institution.
Methods: Data was obtained via a 14-question survey distributed to 72 PICU programs across the US; directed to fellows and APPs to gauge comfort level managing PCP. Nine scenarios were developed for the CSC. Using the certified Imperial Pediatric Emergency Training Toolkit (IPETT), 2 out of 3 impartial graders (2 PCC faculty and 1 APP) scored each scenario individually. Critical performance elements (CPE) were included in each scenario to evaluate physiology knowledge. A descriptive analysis was then conducted on data obtained.
Results: 30 institutions were represented and 50% had CSC. 52% (total n=156) of participants reported feeling "uncomfortable" leading codes. Participants responded feeling "comfortable" in managing PCP preoperatively (70%), postoperatively (68%), and on ECMO (59%), while up to 41% felt "uncomfortable" managing arrhythmias. A Mann-Whitney U test showed that presence of a CSC statistically improved comfort when managing arrhythmias (median 4) vs. institutions without a CSC (median 3),U=1741, z= -2.47, p=.014. Similarly, presence of a CSC statistically improved comfort when managing preoperative patients vs. institutions without a CSC, p=0.045
A total of 12 simulations between September 2020 and June 2021 were available for grading. In 50% of cases, >60% of the CPE were completed (mean:80%) and 4 scenarios had a IPETT score of >70% (mean 77%).
Conclusions: Few programs have a CSC in place, and its presence can improve comfort level in managing arrhythmias in PCP. Implementation of a CSC at our institution has demonstrated that translating cardiac physiology to the bedside can be difficult and assessing knowledge during simulation presents a challenge. Future directions include pairing knowledge questions with CPE to help with this gap.