End-user evaluations of a personal computer-based pediatric advanced life support simulator.

INTRODUCTION: : To inform further development of a personal computer-based Pediatric Advanced Life Support (PALS) simulator, we wished to understand users' perceptions of this new technology. Specifically, we sought to determine whether the simulator was perceived as an effective training tool, whether it filled a gap in the users' current training regimen, and whether these perceptions were impacted by professional affiliation and PALS training history. METHODS: : We surveyed multidisciplinary health care workers in a tertiary care pediatric hospital who used our simulator. RESULTS: : A total of 789 users completed an evaluation of the simulator. Ninety-five percent of respondents agreed that the PALS simulator is an effective educational tool. Eighty-nine percent agreed that the simulator filled a gap in their training, although physicians agreed with this statement more strongly than nurses (P = 0.001). Prior resuscitation training history did not impact whether users perceived that the simulator filled a curricular gap. Users most commonly cited the simulator's realism, its capacity to facilitate practice, and its help feature as the top three qualities they most appreciated. Users' top three suggestions for improving the simulator included provision of a structured tutorial, specific user interface improvements, and encouragement of more widespread access to the simulator. CONCLUSIONS: : Hospital-based pediatric providers are open to using personal computer-based simulation to provide on-demand refresher training in the cognitive aspects of PALS. Through its capacity to reach a large number of health care workers without the need for instructor presence, this technology could be used to help develop a more targeted role for mannequin simulation.

Performance of a consensus scoring algorithm for assessing pediatric advanced life support competency using a computer screen-based simulator.

OBJECTIVE: To develop a computer screen-based simulator that may be used as a pediatric advanced life support (PALS) cognitive skill assessment tool and to pilot test a consensus-based scoring system for the simulator. DESIGN: Development of an evaluation tool, followed by prospective, observational study of tool performance. SETTING: Tertiary care pediatric hospital. SUBJECTS: A total of 100 PALS providers from multiple disciplines. INTERVENTIONS: Using a consensus process with a group of six experts in pediatric emergency and critical care medicine, we developed scoring algorithms to measure performance on four interactive PALS scenarios (supraventricular tachycardia, pulseless electrical activity, ventricular fibrillation, and bradycardia). PALS providers (n = 100) completed the scenarios on the simulator and the computer assessed their performance using the scoring algorithm. MEASUREMENTS AND MAIN RESULTS: Case management scoring audits agreed 100% with computer scoring during pilot testing, indicating excellent reliability. The mean time to complete all four cases was 13.8 mins. Performance scores were highest for supraventricular tachycardia management and lowest for pulseless electrical activity management. Survival was significantly more common than death in the supraventricular tachycardia and ventricular fibrillation scenarios, whereas death was more common in the pulseless electrical activity scenario (p < .004). Physician status predicted a higher aggregate score as well as higher scores in the supraventricular tachycardia (p < .001), pulseless electrical activity (p = .041), and bradycardia (p = .006) scenarios. Participants who completed the PALS course on the same day as their assessment scored higher on the supraventricular tachycardia scenario (p = .041). CONCLUSIONS: Personal computer-based simulation can be used to evaluate performance against consensus criteria in a large number of PALS providers. This technology could supplement traditional curricula by facilitating frequent knowledge assessments as part of a PALS competency maintenance regimen.

Factors influencing nurses' attitudes toward simulation-based education.

OBJECTIVE: To identify barriers to nurses' participation in simulation, and to determine whether prior simulation exposure, professional experience, and practice location influence their tendency to perceive specific issues as barriers. We also sought to identify nurses' educational priorities, and to determine whether these were influenced by years of experience or practice location. METHODS: We surveyed full-time and part-time nurses in a university-affiliated children's hospital to gather data on professional demographics, simulation exposure, perceived barriers to participation in simulation, and training priorities. RESULTS: A total of 523 of 936 (56%) eligible nurses completed the survey. Binary logistic regression analysis revealed that "simulation is 'not the real thing'" was selected as a barrier more often by nurses with prior simulation experience (P = 0.02), fewer years in practice (P = 0.02), and employment in non-acute care areas of the hospital (P = 0.03). "Unfamiliarity with equipment" was reported more often by nurses with less experience (P = 0.01). "Stressful or intimidating environment" was selected more often by those who work in non-acute care areas (P < 0.01). "Providing opportunities to manage rare events" was suggested as a training priority by nurses with less experience (P = 0.08) and by those practicing in acute care areas (P = 0.03). CONCLUSIONS: We identified several barriers to nurses' participation in simulation training. Nurses' tendency to name specific issues as barriers is related to prior simulation exposure, years of experience, and area of hospital practice. Rehearsing rare event management is a priority for less-experienced nurses and those in acute care areas.