P3.225: From Panic to Proficiency: A Simulation-Based Pediatric Trauma Training Initiative

Background: Pediatric trauma management requires rapid, coordinated assessment and intervention to optimize patient outcomes. Pediatric residents often receive limited formal training in trauma care, leading to hesitancy in trauma code participation. To address this gap, we developed a structured, simulation-based education program to augment pediatric residents' confidence and knowledge in trauma care. Our objectives were to evaluate pediatric residents’ confidence, knowledge and performance in trauma simulation after participation in this program.

Methods: We implemented a monthly trauma education program for pediatric residents rotating in a free-standing, inner city, level 1 trauma pediatric emergency department. Each session included a PowerPoint lecture covering ATLS principles, a simulation-based trauma scenario, and a procedural workshop. To assess the program’s short term impact, residents completed pre- and post-intervention surveys measuring self-reported confidence in trauma management alongside a multiple-choice quiz evaluating trauma knowledge retention. Resident performance during standardized trauma simulation was objectively graded using a structured rubric assessing team organization (12 points), primary survey (24 points), and secondary survey (16 points), with a total possible score of 52. Scores were classified as “needs improvement” (0-20), “developing competency” (21-40), and “proficient” (41-52). Residents were grouped by their level of training, and evaluations were conducted as a group rather than individually. Statistical analysis included the Kruskal-Wallis test for differences across training years, Wilcoxon sign-rank test for pre- and post-survey comparisons, and Fisher’s Exact test for categorical variable differences across groups.

Results: Interim analysis of 40 residents showed a significant post-intervention increase in self-reported confidence across multiple trauma management domains, including primary and secondary surveys, c-spine immobilization, and hemorrhage control (Table 1). Mean percentage of correct responses on seven knowledge-based questions significantly increased across all training levels (PGY1: 57.1% to 79.5%, PGY2: 53.2% to 68.8%, PGY3: 52.7% to 73.6%, p < 0.001). Notably, more than half of residents responded incorrectly to secondary survey (67.5% pre vs. 50% post) and GCS scoring (72.5% pre vs. 80% post) specific questions in both the pre and post-survey.

Total mean simulation scores remained in the “developing competency” range, with no significant differences across training years. However, analysis of individual components showed notable variations. In particular, primary survey performance (airway assessment and active bleeding management) and secondary survey total score varied significantly by year of training with both PGY1 and PGY3 performing better then PGY2 (Table 2).

Conclusion: Our structured, simulation-based trauma education program significantly improved pediatric residents’ self-reported confidence and knowledge in trauma management. However, this confidence did not translate in performance in trauma simulation. This gap between perceived confidence and actual performance underscores the critical need for ongoing hands-on training and targeted skill reinforcement. Continuous curriculum refinement can further elevate residents' trauma management proficiency.