Hiroshi Kurosawa1, Takanari Ikeyama, Patricia Achuff, Madeline Perkel, Christine Watson, Annemarie Monachino, Daphne Remy, Ellen Deutsch, Newton Buchanan, Jodee Anderson, Robert A Berg, Vinay M Nadkarni, Akira Nishisaki. 1. 1Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Tokyo Metropolitan Children's Medical Centre, Tokyo, Japan. 3Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, PA. 4Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, PA. 5Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 6Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 7Division of Neonatal and Perinatal Medicine, Oregon Health and Science University, Portland, OR.
Abstract
OBJECTIVE: Recent evidence shows poor retention of Pediatric Advanced Life Support provider skills. Frequent refresher training and in situ simulation are promising interventions. We developed a "Pediatric Advanced Life Support-reconstructed" recertification course by deconstructing the training into six 30-minute in situ simulation scenario sessions delivered over 6 months. We hypothesized that in situ Pediatric Advanced Life Support-reconstructed implementation is feasible and as effective as standard Pediatric Advanced Life Support recertification. DESIGN: A prospective randomized, single-blinded trial. SETTING:Single-center, large, tertiary PICU in a university-affiliated children's hospital. SUBJECTS:Nurses and respiratory therapists in PICU. INTERVENTIONS:Simulation-based modular Pediatric Advanced Life Support recertification training. MEASUREMENTS AND MAIN RESULTS:Simulation-based pre- and postassessment sessions were conducted to evaluate participants' performance. Video-recorded sessions were rated by trained raters blinded to allocation. The primary outcome was skill performance measured by a validated Clinical Performance Tool, and secondary outcome was behavioral performance measured by a Behavioral Assessment Tool. A mixed-effect model was used to account for baseline differences. Forty participants were prospectively randomized to Pediatric Advanced Life Support reconstructed versus standard Pediatric Advanced Life Support with no significant difference in demographics. Clinical Performance Tool score was similar at baseline in both groups and improved after Pediatric Advanced Life Support reconstructed (pre, 16.3 ± 4.1 vs post, 22.4 ± 3.9; p < 0.001), but not after standard Pediatric Advanced Life Support (pre, 14.3 ± 4.7 vs post, 14.9 ± 4.4; p =0.59). Improvement of Clinical Performance Tool was significantly higher in Pediatric Advanced Life Support reconstructed compared with standard Pediatric Advanced Life Support (p = 0.006). Behavioral Assessment Tool improved in both groups: Pediatric Advanced Life Support reconstructed (pre, 33.3 ± 4.5 vs post, 35.9 ± 5.0; p = 0.008) and standard Pediatric Advanced Life Support (pre, 30.5 ± 4.7 vs post, 33.6 ± 4.9; p = 0.02), with no significant difference of improvement between both groups (p = 0.49). CONCLUSIONS: For PICU-based nurses and respiratory therapists, simulation-based "Pediatric Advanced Life Support-reconstructed" in situ training is feasible and more effective than standard Pediatric Advanced Life Support recertification training for skill performance. Both Pediatric Advanced Life Support recertification training courses improved behavioral performance.
RCT Entities:
OBJECTIVE: Recent evidence shows poor retention of Pediatric Advanced Life Support provider skills. Frequent refresher training and in situ simulation are promising interventions. We developed a "Pediatric Advanced Life Support-reconstructed" recertification course by deconstructing the training into six 30-minute in situ simulation scenario sessions delivered over 6 months. We hypothesized that in situ Pediatric Advanced Life Support-reconstructed implementation is feasible and as effective as standard Pediatric Advanced Life Support recertification. DESIGN: A prospective randomized, single-blinded trial. SETTING: Single-center, large, tertiary PICU in a university-affiliated children's hospital. SUBJECTS: Nurses and respiratory therapists in PICU. INTERVENTIONS: Simulation-based modular Pediatric Advanced Life Support recertification training. MEASUREMENTS AND MAIN RESULTS: Simulation-based pre- and postassessment sessions were conducted to evaluate participants' performance. Video-recorded sessions were rated by trained raters blinded to allocation. The primary outcome was skill performance measured by a validated Clinical Performance Tool, and secondary outcome was behavioral performance measured by a Behavioral Assessment Tool. A mixed-effect model was used to account for baseline differences. Forty participants were prospectively randomized to Pediatric Advanced Life Support reconstructed versus standard Pediatric Advanced Life Support with no significant difference in demographics. Clinical Performance Tool score was similar at baseline in both groups and improved after Pediatric Advanced Life Support reconstructed (pre, 16.3 ± 4.1 vs post, 22.4 ± 3.9; p < 0.001), but not after standard Pediatric Advanced Life Support (pre, 14.3 ± 4.7 vs post, 14.9 ± 4.4; p =0.59). Improvement of Clinical Performance Tool was significantly higher in Pediatric Advanced Life Support reconstructed compared with standard Pediatric Advanced Life Support (p = 0.006). Behavioral Assessment Tool improved in both groups: Pediatric Advanced Life Support reconstructed (pre, 33.3 ± 4.5 vs post, 35.9 ± 5.0; p = 0.008) and standard Pediatric Advanced Life Support (pre, 30.5 ± 4.7 vs post, 33.6 ± 4.9; p = 0.02), with no significant difference of improvement between both groups (p = 0.49). CONCLUSIONS: For PICU-based nurses and respiratory therapists, simulation-based "Pediatric Advanced Life Support-reconstructed" in situ training is feasible and more effective than standard Pediatric Advanced Life Support recertification training for skill performance. Both Pediatric Advanced Life Support recertification training courses improved behavioral performance.
Authors: R J MacKinnon; R Stoeter; C Doherty; C Fullwood; A Cheng; V Nadkarni; T Stenfors-Hayes; T P Chang Journal: BMJ Simul Technol Enhanc Learn Date: 2015-10-06
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