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High Fidelity Medical Simulation

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					High Fidelity Medical Simulation as an Assessment Tool for Pediatric Resident
Airway Management Skills

Stephanie N. Sudikoff, MD, Pediatric Critical Care, Hasbro Children’s Hospital
Frank Overly, MD, Marc Shapiro, MD, Pediatric and Adult Emergency Medicine
                   Brown University School of Medicine and the
                  Rhode Island Hospital Medical Simulation Center


High fidelity medical simulation is an evolving tool, currently used for training and, less
frequently, as an assessment tool. Simulation is recommended as a method to assess
ACGME competency, but there is limited pediatric literature on application of simulation
for resident assessment. Having a tool to accurately assess pediatric resident competency
level in acute airway management would be valuable for identifying opportunities for
improvement in resident education and residency program curricula.

In order to evaluate pediatric resident competency in airway management in a high
fidelity medical simulator, we performed a prospective, observational study with 13
PGY-2 pediatric residents who were PALS/APLS certified, and had no prior experience
with medical simulation. Residents were given a brief intro to the simulation center, and
were then required to manage two scenarios. The first scenario was a 3 month old infant
with bronchiolitis, severe respiratory distress, and respiratory failure starting at 240
seconds. The second scenario was a 16 y/o with alcohol intoxication, respiratory
depression, and emesis with aspiration starting at 300 seconds. We recorded time to
critical actions, success rate with procedures, and harmful actions.

During the 26 scenarios, there were 37 attempts at intubation, with 16 failed attempts.
Appropriate pre-oxygenation was performed in 13 of 26 cases. Rapid sequence
intubation (RSI) was administered in 22 of 26 cases, although not always with the
appropriate drugs. Cricoid pressure was applied in 19 of 26 cases, an end-tidal CO2
detector was utilized in 13 of 26 cases, and a nasogastric tube was placed in 11 of 26
cases. Harmful actions included RSI administration prior to preparing intubation
equipment, bag and mask not connected to oxygen, inappropriate endotracheal tube size,
removing cuffed endotracheal tube while cuff inflated, and placing the laryngoscope
blade on backwards.

Our data identified many deficiencies in pediatric resident ability to manage an acute
pediatric airway situation. We feel high fidelity medical simulation could offer a
formative needs assessment tool for residency program directors to use in evaluating the
efficacy of their educational strategy for teaching airway management skills.