P3.Q339: Does simulation boot camp improve resident confidence?

Purpose/Objectives: The aim of this quality improvement project was to augment the comfort and confidence level of junior pediatric residents in management of high-acuity, low-frequency scenarios on the inpatient floor.

Design/Methods: The pediatric residency simulation team planned and organized our institution’s first simulation boot camp aimed at facilitating effective transition of our junior residents into a senior role on the inpatient floors. It was a multidisciplinary collaborative effort that included faculty from Hospital Medicine, Critical Care, Emergency Medicine, and Neonatal Intensive Care departments at Children’s Hospital of Michigan.

A need assessment survey of the pediatric residents guided the content of this intensive 8-hour session. Residents participated as small teams (5-6 members/team) and rotated through a total of 6 stations. Simulation topics included status epilepticus, septic shock, pneumonia, and respiratory failure in a newborn. Each 45-minute session included medical simulation utilizing a high fidelity mannequin followed by faculty guided debriefing and didactic education sessions. Procedural stations included critical vascular access (Interosseous and peripheral IVs) and airway management (Bag mask ventilation, intubation, nasopharyngeal and oropharyngeal airway). Additionally, a 1-hour talk outlining the ins and outs of rapid responses and codes was also delivered. A pre and post-survey was provided at the beginning and end of the simulation boot camp respectively to measure its impact. The survey was divided into 2 parts. The first half consisted of 8 questions primarily assessing the resident’s confidence and comfort level on a 5 point Likert scale. The second part comprised of 7 knowledge-based questions relevant to the lecture and simulation stations.

Results: A total of 29 second year residents participated in this session. Wilcoxon Signed Rank Test was used to compare the pre and post-test survey results. Overall, self-reported comfort and confidence improved significantly (Pretest total score (〖"Median" 〗_before=19) vs. Post-test total score (〖"Median" 〗_after=31), S=203, p<.0001 (table 1). Improvement was noted across all facets, from calling a code to initial assessment and management of a decompensating patient (graph 1 and graph 2). Additionally, knowledge-base related score also improvement significantly (Pretest total score (〖"Median" 〗_before=6) vs. Post-test total score (〖"Median" 〗_after=8), S= -127.5, p< 0.001).

Conclusion/Discussion: A simulation boot camp targeting high-acuity, low-frequency scenarios can be instrumental in improving resident’s skills, knowledge and confidence. Moving forward, an annual simulation boot camp has been integrated into the residency simulation curriculum at our institution.