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Simulation Training with Structured Debriefing Improves Residents’ Pediatric Disaster Triage Performance

  • Mark X. Cicero (a1), Marc A. Auerbach (a1), Jason Zigmont (a2), Antonio Riera (a1), Kevin Ching (a1) and Carl R. Baum (a1)...

Abstract

Introduction

Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners’ acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance.

Methods

A 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations.

Results

A total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001); five months later, there was maintenance of triage improvement, with a mean triage score of 7.8/10 patients (SD = 1.33, P < .0001).

Over-triage of an uninjured child with special health care needs (CSHCN) (67.8% of learners prior to debriefing, 49.0% one week post-debriefing, 26.2% five months post-debriefing) and under-triage of head-injured, unresponsive patients (41.2% of learners pre-debriefing, 37.5% post-debriefing, 11.0% five months post-debriefing) were the most common errors.

Conclusions

Structured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.

Cicero MX, Auerbach MA, Zigmont J, Riera A, Ching K, Baum CR. Simulation training with structured debriefing improves residents’ pediatric disaster triage performance. Prehosp Disaster Med. 2012;27(3):1-6.

Copyright

Corresponding author

Correspondence: Mark X. Cicero, MD Yale University School of Medicine 100 York St., Suite 1F New Haven, CT 06511 USA E-mail mark.cicero@yale.edu

References

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1. Pediatrics Program Requirements. Accreditation Council on Graduate Medical Education. http://www.acgme.org/acWebsite/RRC_320/320_prIndex.asp. Accessed January 24, 2008.
2. Emergency Medicine Program Requirements. Accreditation Council on Graduate Medical Education. http://www.acgme.org/acWebsite/RRC_110/110_prIndex.asp. Accessed January 24, 2008.
3. Ablah, E, Tinius, A, Konda, K. Pediatric emergency preparedness training: are we on a path toward national dissemination? J Trauma. 2009;67(2 Suppl):S152-S158.
4. Behar, S, Upperman, J, Ramirez, M, Dorey, F, Nager, A. Training medical staff for pediatric disaster victims: a comparison of different teaching methods. Am J Disaster Med. 2008;3(4):189-199.
5. Romig, L. Pediatric triage. A system to JumpSTART your triage of young patients at MCIs. JEMS. 2002;27(7):52-58, 60-63.
6. Nie, H, Tang, S, Lau, W, et al. . Triage during the week of the Sichuan earthquake: a review of utilized patient triage, care, and disposition procedures. Injury. 2010;41(5):866-871.
7. Galante, J, Jacoby, R, Anderson, J. Are surgical residents prepared for mass casualty incidents? J Surg Res. 2006;132(1):85-91.
8. Ballow, S, Behar, S, Claudius, I, et al. . Hospital-based disaster preparedness for pediatric patients: how to design a realistic set of drill victims. Am J Disaster Med. 2008;3(3):171-180.
9. Lammers, R, Byrwa, M, Fales, W, Hale, R. Simulation-based assessment of paramedic pediatric resuscitation skills. Prehosp Emerg Care. 2009;13(3):345-356.
10. Timm, N, Kennebeck, S. Impact of disaster drills on patient flow in a pediatric emergency department. Acad Emerg Med. 2008;15(6):544-548.
11. Kaji, A, Coates, W, Fung, C. Medical student participation in a disaster seminar and drill: brief description of activity and report of student experiences. Teach Learn Med. 2010;22(1):28-32.
12. Silenas, R, Akins, R, Parrish, A, Edwards, J. Developing disaster preparedness competence: an experiential learning exercise for multiprofessional education. Teach Learn Med. 2008;20(1):62-68.
13. Moye, P, Pesik, N, Terndrup, T, et al. . Bioterrorism training in U.S. emergency medicine residencies: has it changed since 9/11? Acad Emerg Med. 2007;14(3):221-227.
14. Rudolph, J, Simon, R, Raemer, D, Eppich, W. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med. 2008;15(11):1010-1016.
15. Gentner, D. Psychology of Mental Models. In: Smelser N, Bates P, eds, International Encyclopedia of the Social and Behavioral Sciences. Amsterdam: Elsevier Science; 2002:9683-9687.
16. Cicero, M, Blake, E, Gallant, N, et al. . Impact of an educational intervention on residents’ knowledge of pediatric disaster medicine. Pediatr Emerg Care. 2009;25(7):447-451.
17. Brant, Rollin. Inference for Means: Comparing Two Independent Samples. www.stat.ubc.ca/~rollin/stats/ssize/n2.html. Accessed August 24, 2009.
18. Talente, G, Haist, S, Wilson, J. The relationship between experience with standardized patient examinations and subsequent standardized patient examination performance: a potential problem with standardized patient exam validity. Eval Health Prof. 2007;30(1):64-74.
19. McGaghie, W, Issenberg, S, Petrusa, E, Scalese, R. Effect of practice on standardised learning outcomes in simulation-based medical education. Med Educ. 2006;40(8):792-797.
20. Su, E, Schmidt, T, Mann, N, Zechnich, A. A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course. Acad Emerg Med. 2000;7(7):779-786.
21. Berden, H, Bierens, J, Willems, F, et al. . Resuscitation skills of lay public after recent training. Ann Emerg Med. 1994;23(5):1003-1008.
22. Grant, E, Marczinski, C, Menon, K. Using pediatric advanced life support in pediatric residency training: does the curriculum need resuscitation? Pediatr Crit Care Med. 2007;8(5):433-439.
23. Sutton, D, Stanley, P, Babl, F, Phillips, F. Preventing or accelerating emergency care for children with complex healthcare needs. Arch Dis Child. 2008;93(1):17-22.
24. Sacco, W, Navin, D, Waddell, RK 2nd, et al. . A new resource-constrained triage method applied to victims of penetrating injury. J Trauma. 2007;63(2):316-325.
25. A message from Dr. Romig. http://www.jumpstarttriage.com/Sacco_Triage_Method.php. Accessed March 18, 2012.

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