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AimsTo implement virtual simulation for the PEM training utilizing the Virtual resuscitation room (VRR) during COVID in the paediatric emergency department at The Hospital for Sick ChildrenMethodsAfter need assessment the gaps in the simulation based education for the learners in the paediatric ED were identified. The VRR was identifies as a fit to overcome the barriers. The VRR is a free low cost, interactive, collaborative approach to online simulation based education, adopted from the community ED team. It is a simple platform created using Zoom and google slide interface. The VRR had already been utilized for Medical students and adult EM training with high face validity. Therefore, it was adopted it for PEM. As per the learners needs 12 PEM cases were transformed to the VRR platform including, septic shock, croup, asthma, status epilepticus and DKA. Orientation and training session for using the VRR was organized for simulation fellows, PEM fellows and educators in the department separately. The training sessions were conducted for the Residents, Fellows and EM trainees and Community EM physicians. Debriefing was conducted utilizing the plus delta methodology with a standardized checklist provided to Facilitators. Feedback from both facilitators and learners were taken after each session regarding its Usability and feasibility.ResultsTotal 10 sessions with 120 learners had been provided simulation based Education using the VRR. Total 12 common Paediatric PEM cases were developed to entail the need of the learners. There were 30% junior learners and 70% senior learners. Facilitators described it easy to use tool (83%) and feasibility in developing new cases (77%). They were able to modify or increase complexity as per the level of learners(80%) and interactive (86%). The facilitators felt that it was not useful in teaching resuscitation procedural skills (87%). The Learners feedback was taken on the Likert scale of 1-5 where 1 was least likely and 5 was most likely. Ninety seven percent of learner rated 4.4 out of 5 when said that they learnt something that is applicable to their clinical practise, 82% rated 4.3 out of 5 about the fact that the physiological clues, props, technology, and environment facilitated learning on VRR. The Debriefing was rated as 4.8/5 by 92% of the learners using the virtual platform. 97% of the learners were felt engaged in the virtual simulation and 94% felt that clinical clues provided like respiratory distress, capillary refill time, seizures were felt real. Most of the learners (87%) said that that difficult to learn procedural task.ConclusionVRR was found to be a feasible and useful platform to deliver simulation based education for PEM learners.

AimsAim1. To perform a needs assessment to understand the existing gaps in training for neonatal resuscitation care among interprofessional team members in the emergency department at SickKids.2. To develop a virtual simulation-based neonatal resuscitation care curriculum and conduct usability testing to refine the design of the cases that comprise the online curriculum.Methods Methodology: This project involves two phases: (1) needs assessment and (2) curriculum development and refinement. Phase I: Need assessment : Needs assessment will be carried out to determine the needs of healthcare providers involved in NNR in the emergency room. While there is no established approach on how best to perform a faculty needs assessment. We have we have selected an exploratory approach using an electronic survey and institutional document review. The results will be used to inform the development of the virtual NNR curriculum, comprised of 3 VS cases. The survey will be distributed via email to permanent and contract physicians, advanced subspecialty fellows, registered nurses and respiratory therapist working in the SickKids ED. Phase II: Curriculum development and refinement-The NNR curriculum will be comprised of 3 VS cases and will be developed based on Kern et al.’s six-step approach to curriculum development, including problem identification and needs assessment (Phase I), goals and objectives and educational strategies (Phase II), and implementation and evaluation (Phase III, future work) . Sample Size: Ten participants per usability cycle should identify most issues as previous studies have reported that even with a small representative sample of end users (5 participants), 80% of usability issues are identified.Results Analysis Plan: Demographic data: Descriptive statistics including measures of central tendency and distribution of values. Usability data: Audiotaped usability testing interviews and field notes will be transcribed verbatim, deidentified, and entered Dedoose qualitative data analysis software to facilitate organization and analysis. After each iterative cycle, common and recurring themes related to usability (i.e., satisfaction, efficiency, errors) will be identified through systematic iterative coding and sorting using the constant comparison method. Two team members will individually read transcripts to identify preliminary codes. Regular team meetings will be held to refine and merge codes into thematic categories in a consensus-building process until a stable thematic structure is developed. This coding structure will then be applied to the entire data set by one researcher. Modifications to the VS cases will be made based on findings from each usability testing cycle. System Usability Scale scores will be summed and converted to percentiles; with a score of greater than 68% considered average. Sample Size: Ten participants per usability cycle should identify most issues as previous studies have reported that even with a small representative sample of end users (5 participants), 80% of usability issues are identified.Conclusion Impact: This study will result in the development of a VS curriculum in neonatal emergency readiness; an identified priority area for continued improvement within the SickKids PEM department. We will translate our knowledge using the Knowledge to Action loop. Keywords: Virtual simulation, Virtual Resuscitation Room, Pediatric emergency.

AimsTo implement a structured debriefing process in 60% of eligible events in the emergency department (ED) at The Hospital for Sick Children over a 6-month period to ultimately identify and track performance gaps.MethodsThe Hotwash Emergency Resuscitation Debriefing (HERD) process is being implemented through quality improvement methodology at our institution. Measures include debrief participants and duration (process), number of events debriefed and performance gaps identified (outcome) and user satisfaction (balancing). As part of the HERD process, senior nurses and physicians, with minimal debriefing expertise, are expected to co-lead an immediate short debrief by using a structured debriefing tool called the ‘ED-Hotwash’. This was adapted from an internally developed tool and focuses on identifying individual, team and system-based performance gaps, as recommended by the American Heart Association. ED providers are expected to debrief any resuscitations leading to PICU/NICU admission, Trauma, death or if a team member felt it was warranted. Identified performance gaps are classified based a modified SEIPPS framework and reviewed at monthly meetings where issues are acted uponResultsThere were 22 eligible events that occurred between January and March 2021, including 10 (45%) resuscitations with PICU admission and 9 (41%) trauma activation and most events occurring overnight or on weekends (17/22, 77%). 17/22 events were debriefed (77%) and reasons not to debrief included a ‘busy ED’ or ‘near handover time’. Most debriefs were led by senior nurses (12/17, 71%) and lasted 15 minutes on average. 4.8 performance gaps were identified per debrief with most being team or systems based. Equipment usability not being optimised was a common theme across all events. Providers were satisfied with the tool (9.3/10 on 10-point Likert scale) and felt it was ‘Easy and quick to use’ and a ‘great tool to keep us on track’. ConclusionDebriefing acute critical events in the ED should be standard of care and implementing a standardised process through quality improvement methodology helps identify and track performance gaps.

AimsManaging pediatric emergencies is a core competency for medical learners, however clinical exposure varies widely during training. Thus, the Hospital for Sick Children established a standardized simulation-based Junior Mock Code (JMC) curriculum (figure 1) for first- and second-year residents.However, trainee and facilitator feedback identified persistent learning gaps, highlighting core pediatric emergencies that were missing from the original curriculum. We aimed to develop a hybrid simulation-based curriculum with complementary interactive asynchronous learning modules (figure 2) to better bridge these gaps.MethodsUsing the Kern Curriculum Development Model,1,2 we identified common clinical performance weaknesses, knowledge gaps, and low-frequency clinical exposures for junior trainees. We then prioritized the topics to be included in the new curriculum and established its goals and objectives: to provide supplement clinical exposure to core pediatric emergencies, including critical but low-frequency presentations (pediatric trauma and neonatal shock), through simulation-based education and complementary interactive asynchronous learning modules using the AffinityLearning™ platform. We launched our pilot in January 2022. Using Quality Improvement methodology including Plan, Do, Study, Act (PDSA) cycles, we are conducting multiple iterations of feedback collection from learners and facilitators and subsequent curriculum revisions.ResultsOur first PDSA cycle was gathering stakeholder feedback from a departmental curriculum presentation prior to launch. Pediatric Emergency Medicine faculty and trainees overall responded very positively to the content changes from the previous curriculum and further feedback on logistics, academic potential, and networking opportunities was provided. These logistic suggestions were implemented in designing a curriculum dissemination protocol with administrative support staff. Our second cycle was a peer review of the module content and technological functionality by pediatric emergency medicine faculty and senior trainees, and feedback from this peer review was integrated prior to curriculum launch.Our current cycle started with curriculum implementation and focuses on learner reactions (Kirkpatrick level 1) and learner knowledge retention (Kirkpatrick level 2) outcomes based on feedback surveys for the asynchronous learning modules and aggregate learner performance reports on self-assessment activities embedded in each module.Abstract 789 Figure 1Current CurriculumAbstract 789 Figure 2New CurriculumConclusionFuture steps for this curriculum will include assessing trainee performance/competency scores during simulation sessions and correlating these with their performance on the preceding complementary asynchronous e-learning modules (Kirkpatrick level 3 learning outcomes). We will also continuously expand the library of e-learning modules to further bridge learning gaps for junior trainees, empowering them to reflect on their knowledge and areas for improvement as self-directed adult learners.ReferencesThomas PA, et al. Curriculum Development for Medical Education: A Six-Step Approach.Barsuk JH, et al. Developing a Simulation-Based Mastery Learning Curriculum.Kurt S. Kirkpatrick Model: Four Levels of Learning Evaluation.

The aim of our study was to analyze the use of interpreter services and improve communication during health encounters with families with limited language proficiency (LLP) at the pediatric emergency department (ED) of the University Hospital of Bern. This study is a pre- and post-intervention study analyzing the use of interpreter services for LLP families. All families originating from a country with a native language other than German, English or French presenting to the ED were eligible to participate in the study. If they agreed to participate, the language proficiency of the caregiver present during the health encounter was systematically assessed during a phone interview within a few days after the consultation, using a standardized screening tool. If screened positive (relevant LLP), a second phone interview with an interpreter was conducted. Further variables were extracted including nationality, age, gender and date of visit using administrative health records. To increase the use of interpreter services, a package of interventions was implemented at the department during 3 months. It consisted of: i) in person and online transcultural teaching ii) awareness raising through the regular information channels and iii) the introduction of a pathway to systematically identify and manage LLP families. The proportion of LLP families who received an interpreter was 11.0% (14/127) in the pre-intervention period compared to 14.8% (20/135) in the post-intervention period. The interpreter use was therefore increased by 3.8% (95% CI − 0.43 to 0.21; p  = 0.36). The assessed level of language proficiency of caregivers differed from the self-reported level of language proficiency. Of the study participants in the interview whose language proficiency was screened as limited, 77.1% estimated their language proficiency level as intermediate. More than half of the LLP families who did not receive an interpreter and participated in the interview reported, that they would have liked an interpreter during the consultation. Conclusions: Interpreter services are largely underused during health encounters with LLP families. Relying on caregivers´ self-assessed language proficiency and their active request for an interpreter is not sufficient to ensure safe communication during health encounters. Systematic screening of language proficiency and standardized management of LLP families is feasible and needed at health care facilities to ensure equitable care. Further studies are needed to analyze personal and institutional barriers to interpreter use and find interventions to sustainably increase the use of interpreter services for LLP families.

Health care educators may enhance learning with thoughtful incorporation of game elements. Gamification has shown success across various fields in medical education. It has demonstrated deeper engagement by leveraging both intrinsic and extrinsic motivational factors. While beneficial, gamification requires thoughtful implementation to increase active learning and avoid potential negative effects, such as unhealthy competition. Serious games integrate learning objectives directly within their framework, making the educational experience an intrinsic part of gameplay. These games are specifically designed to enhance knowledge and skills while promoting decision making, teamwork, and communication. The immersive nature of serious games requires players to actively engage and apply their knowledge to solve complex problems. Serious games and simulation represent transformative educational approaches that not only enhance learning and retention but also develop essential competencies crucial for health care professionals. These strategies, when combined with effective debriefing, provide a robust framework to enrich education and training in health care. [Pediatr Ann. 2024;53(11):e401–e407.]

Objective To evaluate the accuracy of Google Translate (GT) in translating low-acuity paediatric emergency consultations involving respiratory symptoms and fever, and to examine legal and policy implications of using AI-based language interpretation in healthcare. Methods Based on the methodology used for conducting language performance testing routinely at the Interpreter Services Department of the Hospital for Sick Children, clinical performance testing was completed using a paediatric emergency scenario (child with respiratory illness and fever) on five languages: Spanish, French, Urdu, Arabic, and Mandarin. The study focused on GT's translation accuracy and a legal and policy evaluation regarding AI-based interpretation in healthcare was conducted by legal scholars. Results GT demonstrated strong translation performance, with accuracy rates from 83.5% in Urdu to 95.4% in French. Challenges included dialect sensitivity and pronoun misinterpretations. Legal evaluation indicated inconsistent access to language interpretation services across healthcare jurisdictions and potential risks involving data privacy, consent, and malpractice when using AI-based translation tools. Conclusions Google Translate can effectively support communication in specific non-critical paediatric emergency scenarios. However, its use necessitates careful monitoring, understanding of its limitations, and attention to dialect and literal translation risks along with equity considerations. Establishing legal and policy frameworks for language interpretation in healthcare is crucial, alongside addressing funding and data security concerns, to optimize the use of AI-based translation tools in healthcare contexts.

ObjectivesCommunication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy.DesignA mixed-methods study.SettingPaediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland.Participants and methodsCaregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted.ResultsThe study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy.ConclusionThe use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well—positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety.

Background Three-Dimensional (3D) printing, also known as additive manufacturing (Linke, Additive manufacturing, explained, 2017), has rapidly emerged as a transformative tool in healthcare simulation. This scoping review investigates simulation educators' knowledge, skills, and attitudes (KSAs) about the impact of 3D printing and explores 3D printing’s broader applications in healthcare simulation. By synthesizing existing literature, this study aims to identify trends, challenges, and opportunities for integrating 3D printing into simulation-based education. Main body The review followed the PRISMA-ScR framework, employing a six-step approach. A comprehensive search was conducted across databases, including PubMed, Medline, ERIC, CINAHL, and Google Scholar, covering studies published between 2000 and 2023. Keywords related to 3D printing and simulation-based education were used. Inclusion criteria focused on peer-reviewed articles discussing 3D printing's role in KSAs for simulation educators and its applications in healthcare simulation. Articles were charted and analyzed thematically to identify trends, challenges, and outcomes. A total of 181 studies were included, spanning 36 countries and 113 journals. Most studies focused on medical education, with 73% utilizing 3D-printed models for direct teaching. Key themes identified included realism, skill development, cost-effectiveness, and teaching effectiveness. Challenges included model accuracy, training gaps for educators, and resource limitations. Study designs were predominantly descriptive, with a significant portion being single-site case reports. Conclusion 3D printing has the potential to revolutionize simulation-based education by enhancing realism, accessibility, and skill development. However, gaps in educator training and methodological rigor must be addressed. Future research should focus on multi-institutional studies and long-term outcomes to maximize the impact of the technology.