Implementation of a North American pediatric emergency medicine simulation curriculum using the virtual resuscitation room.

Background: Simulation provides consistent opportunities for residents to practice high-stakes, low-frequency events such as pediatric resuscitations. To increase standardization across North American residency programs, the Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds) was developed. However, access to high-quality simulation/pediatric expertise is not uniform. As the concurrent COVID-19 pandemic necessitated new virtual simulation methods, we adapted the Virtual Resus Room (VRR) to teach EM ReSCu Peds. VRR is an award-winning, low-resource, open-access distance telesimulation platform we hypothesize will be effective and scalable for teaching this curriculum. Methods: EM residents completed six VRR EM ReSCu Peds simulation cases and received immediate facilitator-led teledebriefing. Learners completed retrospective pre-post surveys after each case. Learners and facilitators completed end-of-day surveys. Primary outcomes were learning effectiveness measured by a composite of the Simulation Effectiveness in Teaching Modified (SET-M) tool and self-reported changes in learner comfort with case objectives. Secondary outcome was VRR scalability to teach EM ReSCu Peds using a composite outcome of net promoter scores (NPS), resource utilization, open-text feedback, and technical issues. Results: Learners reported significantly increased comfort with 95% (54/57) of EM ReSCu Peds-defined case objectives (91% cognitive, 9% psychomotor), with moderate (Cohen's d 0.71, 95% CI 0.67-0.76) overall effect size. SET-M responses indicated simulation effectiveness, particularly with debriefing. Ninety EM residents from three North American residency programs were taught by 59 pediatric faculty from six programs over 4 days-more than possible if simulations were conducted in person. Learners (39) and faculty (68) NPS were above software industry benchmarks (13). Minor, quickly resolved, technical issues were reported by 18% and 29% of learners and facilitators, respectively. Conclusions: Learners and facilitators report that the VRR is an effective and scalable platform to teach EM ReSCu Peds. This low-cost, accessible distance simulation intervention could increase equitable, global access to high-quality pediatric emergency education.

International Pediatric Emergency Medicine and Critical Care Fellow Education: Utilizing Virtual Resuscitation Simulation in Settings With Differing Resources.

Pediatric Emergency and Critical Care-Kenya (PECC-Kenya) is an international collaboration between the University of Nairobi and the University of Washington (UW) supporting a combined fellowship program in pediatric emergency medicine (PEM) and pediatric critical care medicine (PCCM) in Kenya. Typically, PEM/PCCM faculty from UW travel to Kenya to support in-person simulation, which was cancelled due to COVID-19 travel restrictions. This presented a need for alternative modalities to continue simulation-based education. This technical report describes the use of virtual simulation for pediatric emergency and critical care fellow education on the management of hypovolemic and septic shock, utilizing international guidelines and being based on resource availability.

Pediatric Emergency Medicine Didactics and Simulation (PEMDAS) Telesimulation Series: Hyperleukocytosis.

Introduction: Hyperleukocytosis, an infrequent presentation of new-onset leukemia, is a medical emergency requiring prompt recognition and treatment. It can include altered mental status, fever, critical electrolyte derangements, and coagulopathies. Due to the COVID-19 pandemic, this simulation was created as a telesimulation in order to adhere to mandatory physical distancing guidelines while addressing learning objectives. Methods: This simulation was designed for pediatric emergency medicine fellows and featured a pediatric patient presenting with fever, altered mental status, and respiratory distress. After an initial assessment and appropriate workup, the patient developed tumor lysis syndrome, coagulopathies, and new-onset neurologic changes requiring appropriate interventions. A debriefing guide and participant evaluation form were utilized. Results: This telesimulation was implemented at five different institutions, with evaluation surveys completed by 22 pediatric emergency medicine fellows. The scenario was rated on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) and was generally well received, with participants rating the simulation as effective in teaching the recognition (M = 4.8) and management (M = 4.6) of hyperleukocytosis. Participants felt that virtual telesimulation was effective compared to other distance learning methods (M = 3.9). Discussion: This simulation-based curriculum allows learners to practice identifying and managing hyperleukocytosis. We found that it was well received in both in-person and virtual formats.

Nitrous Oxide Sedation Asynchronous Curriculum for Pediatric Emergency Medicine Providers.

This technical report describes a nitrous oxide sedation training curriculum for pediatric emergency medicine providers. This curriculum was used during the novel coronavirus disease 2019 (COVID-19) pandemic where in-person classroom training was significantly limited. We demonstrate a model for concept and equipment learning with video-guided self-practice in place of in-person training with a facilitator. A similar model can be utilized for other equipment or concept training.

TeleSimBox: A perceived effective alternative for experiential learning for medical student education with social distancing requirements.

INTRODUCTION: During the COVID-19 pandemic the Association of American Medical Colleges recommended that medical students not be involved with in-person patient care or teaching, necessitating alternative learning opportunities. Subsequently we developed the telesimulation education platform: TeleSimBox. We hypothesized that this remote simulation platform would be feasible and acceptable for faculty use and a perceived effective method for medical student education. METHODS: Twenty-one telesimulations were conducted with students and educators at four U.S. medical schools. Sessions were run by cofacilitator dyads with four to 10 clerkship-level students per session. Facilitators were provided training materials. User-perceived effectiveness and acceptability were evaluated via descriptive analysis of survey responses to the Modified Simulation Effectiveness Tool (SET-M), Net Promoter Score (NPS), and Likert-scale questions. RESULTS: Approximately one-quarter of students and all facilitators completed surveys. Users perceived that the sessions were effective in teaching medical knowledge and teamwork, though less effective for family communication and skills. Users perceived that the telesimulations were comparable to other distance learning and to in-person simulation. The tool was overall positively promoted. CONCLUSION: Users overall positively scored our medical student telesimulation tool on the SET-M objectives and promoted the experience to colleagues on the NPS. The next steps are to further optimize the tool.

Tips for Conducting Telesimulation-Based Medical Education.

Telesimulation utilizes communications technology, such as video conferencing platforms, to provide simulation-based medical education when participants and facilitators are geographically separated. Learners interact with each other, embedded participants, and a simulated patient and/or vital sign display on the computer screen. Facilitators observe the learners in real-time and provide immediate feedback during a remote debrief. Telesimulation obviates the need to have instructors, learners, and high fidelity patient simulators (HPS) in the same place, allowing simulation-based educational sessions to occur in institutions located remotely from simulation centers or when other barriers limit in-person education and/or training. For example, due to the novel coronavirus (COVID-19) pandemic, many medical education programs temporarily discontinued in-person simulations to adhere to physical distancing guidelines. The authors have reflected upon their experiences executing telesimulation sessions since the start of the pandemic and provide these 12 tips as practical suggestions on how to successfully implement telesimulations with medical trainees. These tips are intended to guide implementation and facilitation by staff and faculty trained in simulation.