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Simulation Training with Structured Debriefing Improves Residents’ Pediatric Disaster Triage Performance

Published online by Cambridge University Press:  13 June 2012

Mark X. Cicero ,
Marc A. Auerbach ,
Jason Zigmont ,
Antonio Riera ,
Kevin Ching  and
Carl R. Baum
Mark X. Cicero*
Affiliation:
Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
Marc A. Auerbach
Affiliation:
Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
Jason Zigmont
Affiliation:
SYN:APSE Simulation Center, Yale-New Haven Hospital, New Haven, Connecticut USA
Antonio Riera
Affiliation:
Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
Kevin Ching
Affiliation:
Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
Carl R. Baum
Affiliation:
Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA
*
Correspondence: Mark X. Cicero, MD Yale University School of Medicine 100 York St., Suite 1F New Haven, CT 06511 USA E-mail mark.cicero@yale.edu
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Abstract

Introduction

Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners’ acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance.

Methods

A 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations.

Results

A total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001); five months later, there was maintenance of triage improvement, with a mean triage score of 7.8/10 patients (SD = 1.33, P < .0001).

Over-triage of an uninjured child with special health care needs (CSHCN) (67.8% of learners prior to debriefing, 49.0% one week post-debriefing, 26.2% five months post-debriefing) and under-triage of head-injured, unresponsive patients (41.2% of learners pre-debriefing, 37.5% post-debriefing, 11.0% five months post-debriefing) were the most common errors.

Conclusions

Structured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.

Cicero MX, Auerbach MA, Zigmont J, Riera A, Ching K, Baum CR. Simulation training with structured debriefing improves residents’ pediatric disaster triage performance. Prehosp Disaster Med. 2012;27(3):1-6.

Keywords

pediatricresidentsimulationtrainingtriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 3 , June 2012 , pp. 239 - 244
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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