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.

Developing the Virtual Resus Room: Fidelity, Usability, Acceptability, and Applicability of a Virtual Simulation for Teaching and Learning.

PROBLEM: Physical distancing restrictions during the COVID-19 pandemic led to the transition from in-person to online teaching for many medical educators. This report describes the Virtual Resus Room (VRR)-a free, novel, open-access resource for running collaborative online simulations. APPROACH: The lead author created the VRR in May 2020 to give learners the opportunity to rehearse their crisis resource management skills by working as a team to complete virtual tasks. The VRR uses Google Slides to link participants to the virtual environment and Zoom to link participants to each other. Students and facilitators in the emergency medicine clerkship at McMaster University used the VRR to run 2 cases between June and August 2020. Students and facilitators completed a postsession survey to assess usability and acceptability, applicability for learning or teaching, and fidelity. In addition, students took a knowledge test pre- and postsession. OUTCOMES: Forty-six students and 11 facilitators completed the postsession surveys. Facilitators and students rated the VRR's usability and acceptability, applicability for learning and teaching, and fidelity highly. Students showed a significant improvement in their postsession (mean = 89.06, standard deviation [SD] = 9.56) compared with their presession knowledge scores (mean = 71.17, SD = 15.77; t(34) = 7.28, P < .001, with a large effect size Cohen's d = 1.23). Two perceived learning outcomes were identified: content learning and communication skills development. The total time spent (in minutes) facilitating VRR simulations (mean = 119, SD = 36) was significantly lower than time spent leading in-person simulations (mean = 181, SD = 58; U = 20.50, P < .008). NEXT STEPS: Next steps will include expanding the evaluation of the VRR to include participants from additional learner levels, from varying sites, and from other health professions.