Feedback is a key feature of effective medical simulation

1
RePedSim Repetitive Pediatric Simulation
Training Marc Auerbach MD, David Kessler MD, and
Jessica Foltin MD Bellevue Hospital Center and
NYU School of Medicine, Department of Pediatrics,
Division of Pediatric Emergency Medicine
METHODS
BACKGROUND
CONCLUSIONS

• Design
• Prospective pilot study of an novel debriefing
  method
• Setting In-situ simulation room on pediatric
  in-patient ward
• Learners New York University/Bellevue
  Hospital Pediatric Residents 2008-2009
• Group size four learners, two faculty
  (fellow/attending)
• Statistics Mann-Whitney U test compared
  Likert scale responses
• Data Collection
• Anonymous, self-reported survey
• Five-point Likert Scale completed after each
  simulation session by learners
• 1strongly disagree, 2slightly disagree,
  3neutral, 4slightly agree, 5strongly agree
• Groups
• Non-RePedSim conventional debriefing after
  simulation session (03/08 to 09/08)
• RePedSim conventional debriefing followed by
  repetition of scenario (10/08-12/08)

• Feedback is a key feature of effective medical
  simulation
• Little evidence on what is the best method for
  debriefing
• Opportunities to apply the knowledge and skills
  discussed during debriefing could improve
  retention

• Repetition with a chance to correct errors
  results in improved self-reported effectiveness
  of simulation sessions
• The opportunity to immediately respond to
  feedback may improve retention of rarely used
  skills

OBJECTIVES

• To compare knowledge, skills, and confidence of
  learners and subjective quality between groups
• Standard debriefing format
• RePedSim debriefing format

LIMITATIONS

• Single clinical site, small sample size
• Self-reported data at a single time point
• No test for retention

RePedSim Format
RESULTS
FUTURE DIRECTIONS

• Trainees requested an opportunity to repeat
  simulations after debriefing to apply their
  skills
• Training sessions restructured in response to
  feedback
• Example of RePedSim format
• Anaphylaxis case- fair performance
• Debrief- discuss early administration of
  epinephrine
• Repetition anaphylaxis case- improved performance
• Debrief- reinforcement

• Prior Experience
• Mean Self Reported Five-point Likert Scores

• Correlate RePedSim training with improved
  retention
• Explore effect on clinical performance
• Develop an optimal debriefing model

RePedSim N 106 StandardSim N 23
Simulation Experiences (mean) 3.1 /- 0.2 2.8 /- 0.5
Real Code Experiences (mean) 1.5 /- 0.2 1.2 /- 0.4
Post Graduate Year (mean) 1.5 1.5
THANK YOU TO OUR RESIDENTS
Research supported by rbabyfoundation.org and
KiDS of NYU
Standard Format
RePedSIm StandardSim P-value
Improved my knowledge 4.6/-0.5 4.2/-0.7 0.022
Improved my skills 4.5/-0.6 3.9/-0.7 0.002
Improved my confidence 4.3/-0.6 4.1/-0.8 0.25
Was effective for teaching 4.9/-0.3 4.1/-0.8 lt0.0005
Was effective for evaluation 4.6/-0.6 4.2/-0.8 0.045
Debriefing was of high quality 4.8/-0.4 4.4/-0 0.044

• The learner engages in practice followed by
  feedback
• Session ends after debriefing

P-value for Mann-Whitney U Mean Ranks