Journal Article

55 Outside the comfort zone: Evaluation of a simulation-based curriculum in managing agitated patients for paediatric residents

Fleming, Lindsay, Kulkarni, Chetana, Hick, Katherine, Lorber, Sharon

2019

Overview

Background Given the prevalence of mental health comorbidity in the paediatric population, it is important that paediatricians/paediatric trainees possess competence in the management of acute psychiatric emergencies, including agitation. Experiential learning through simulation is used for safety training when high-risk decisions must be made safely and rapidly. Simulation-based training in the management of acutely agitated patients has been studied in the context of psychiatric training programs; however, limited studies exist to inform effective methods of training paediatric residents in the management of agitation. Objectives This study assessed a simulation-based workshop on the knowledge, competence and confidence of paediatric trainees in the management of agitated patients compared to a didactic lecture or no formal educational intervention. Design/Methods This was a prospective comparative cohort study. Paediatric residents were divided among three study groups: Group 1 - a 1-hour didactic lecture on agitation management; Group 2 - a simulation-based workshop on managing the agitated patient; and Group 3 -no intervention. Confidence and knowledge were assessed in groups 1 and 2 using a pre- and post- intervention self-efficacy questionnaire and a clinical vignette. All three groups completed an agitated patient station in the 2018 in-training Objective Structured Clinical Examination (OSCE) assessment. Univariate analysis was completed on the pre- and post- intervention self-efficacy questionnaires, and clinical vignette scores were analyzed using a t-test. Analysis of variance was used to compare OSCE scores between groups. A subgroup analysis was performed to assess OSCE scores by postgraduate year (PGY). Results Simulation-based workshop participants performed better in the OSCE scenario as demonstrated by their OSCE score (mean 81.7%, CI: 75.1–88.3) compared to those from groups 1 (mean 74.6%, CI: 71.4–77.8) and 3 (mean 71.6%, CI: 69.2–74.0). The most significant difference was present between groups 2 and 3 (p=0.0055), whereas differences in the means between groups 1 and 2 were not as prominent (p=0.0577). No difference in mean OSCE scores was found between groups 1 and 3 (p= 0.1424). Subgroup analysis of OSCE scores by PGY of training did not demonstrate a statistically significant difference (p=0.0615). Scores for this scenario did not improve with increased level of training, demonstrating a persistent knowledge gap amongst trainees. Conclusion Simulation-based learning may be an effective educational strategy for paediatric residents to acquire skills in managing acute agitation.

• Publisher: Oxford University Press
• Subject: Abstract / Résumés / Curricula / Delirium / Medical education / Pediatrics / Physicians / Simulation