P3.241: Enhancing Trainee Confidence and Knowledge in Managing Clinical Emergencies: A Research Initiative Using Systems Based Simulations in a Pediatric Residency Program

Background: Simulation-based educational interventions (SBEIs) are essential in pediatric residency training, providing a safe environment to practice managing high-risk clinical emergencies. Simulation offers educational advantages, such as scenario standardization and deliberate practice opportunities without risking patient safety (Cheng et al., 2014). Considering simulation as a "pharmacologic agent" highlights the need for intentional design to maximize educational impact while minimizing drawbacks (Weinger, 2010). In pediatrics, simulation effectively enhances knowledge, procedural skills, and crisis resource management, which are vital for optimizing patient care. Systems-based simulations further assess performance at individual, team, and system levels, identifying latent safety threats and improving clinical processes (Cheng et al., 2014). Despite the benefits, variability in pediatric trainees’ exposure and confidence persists (Cheng et al., 2013). This initiative aimed to assess the impact of systems-based simulation on pediatric residents’ self-reported degree of confidence in managing clinical emergencies.

Methods: Residents participated in systems-based simulation sessions focused on key pediatric emergencies over a ten month period: Respiratory (status asthmaticus, respiratory failure), Cardiovascular (supraventricular tachycardia, ventricular fibrillation), Neurologic (status epilepticus), Metabolic (hyperkalemia, hypoglycemia), Toxicologic (tricyclic antidepressant overdose) and Allergy/Immunology (anaphylaxis). The sessions were facilitated by pediatric ICU attending, chief residents and experienced paramedics. Pre and post simulation surveys assessed trainee confidence using a 5-point Likert Scale (0 = Not Confident, 1 = Slightly Confident, 2 = Neutral, 3 = Confident, 4 = Very Confident). Structured debriefings provided individualized and team feedback. Statistical analysis was performed utilizing a Wilcoxon Signed-Rank Test.

Results: Mean confidence scores derived from pre and post simulation surveys completed by thirty pediatric residents increased significantly across all systems: Respiratory (2.37 to 3.06), Cardiac (1.73 to 2.8), Neurologic (2.24 to 2.83), Metabolic (2.16 to 2.94), Toxicologic (1.92 to 2.67), and Allergy/Immunology (1.35 to 3.25), as supported by the Wilcoxon Signed Rank Test, (W+ = 21, p = 0.031, r = 0.88). The Median of Mean Confidence Scores improved from 2.0(Neutral) to 2.9 (Confident). The large effect size (r = 0.88) suggests substantial improvement in confidence across all clinical categories. Power analysis with an effect size of 0.88, alpha-error probability of 0.05 yielded a power of 0.8075 (80.75%). This suggests a high probability that the study was adequately powered to detect the observed effect.

Conclusion: Systems-based simulation significantly enhanced pediatric residents’ perceived confidence in managing clinical emergencies within the simulation environment. Targeted scenarios and structured debriefing likely contributed to improved clinical decision-making and teamwork. The findings of this study support simulation as an impactful training mechanism, which empowers trainees to feel confident during high-stakes clinical situations. Future studies could investigate trainee confidence and competence during actual clinical emergencies, as well as the retention of knowledge through spaced repetition of systems-based simulations, to further clarify their role in pediatric residency training.