Stokes Stacey T, Ismail Lana, Creamer Kevin M
Department of Pediatrics/Division of Hospital Medicine, Children's National Hospital, Washington, DC, USA.
Cureus. 2024 Dec 2;16(12):e74974. doi: 10.7759/cureus.74974. eCollection 2024 Dec.
Medical simulation education has expanded in the remote learning sphere, providing educational opportunities to under-resourced areas and the ability to engage learners limited by time or geographic location. Pediatric resuscitation training has historically been in-person relying on Pediatric Advanced Life Support (PALS) algorithms, yet many pediatric providers are often faced with treating adult or adult-sized patients. Our goal was to develop a tele-simulation remote learning module highlighting possible diagnoses and scenarios that require adult treatment-minded approaches for the pediatric clinician, including the use of Advanced Cardiac Life Support (ACLS) algorithms.
This simulation curriculum was offered in 2020 and 2022. The sessions were created for pediatric hospitalists and presented over an online video platform with visual aids to simulate being in a patient room. All three cases had the same base stem scenario and focused on a narcotic overdose, massive pulmonary embolism (PE), and torsades de pointes from polypharmacy-induced QTc prolongation. A multimodal assessment approach captured post-simulation comfort level with case content, information recall up to two years later, and pre- and post-test assessments of clinical knowledge improvement.
Eighty-one simulation slots were filled by 56 clinicians over two years. Fifty-one completed course evaluations averaged a score of 4.95 on a 5-point Likert scale survey. Increased comfort level was statistically significant across all learning objectives. The most significant improvements were in the domains of ACLS algorithm use and understanding when to terminate unsuccessful resuscitation efforts. Pre- and post-test results demonstrated statistically significant (p<0.001) evidence of knowledge transfer in ACLS and PALS content.
Tele-simulation using an online video platform and well-defined visual aids is a useful option when in-person resuscitation simulation is not available. Practice and reinforcement of ACLS algorithms in pediatrics was found to be meaningful to clinicians who take care of patients of varying ages and sizes.
医学模拟教育在远程学习领域不断扩展，为资源匮乏地区提供了教育机会，也使受时间或地理位置限制的学习者能够参与其中。儿科复苏培训历来都是面对面进行的，依赖于儿科高级生命支持（PALS）算法，但许多儿科医疗人员经常需要治疗成人或体型如成人的患者。我们的目标是开发一个远程模拟学习模块，突出可能的诊断和场景，这些诊断和场景要求儿科临床医生采用具有成人治疗思维的方法，包括使用高级心血管生命支持（ACLS）算法。
该模拟课程于2020年和2022年提供。课程面向儿科住院医师，通过在线视频平台授课，并配有视觉辅助工具以模拟身处病房的情景。所有三个病例都有相同的基本主干情景，重点是麻醉剂过量、大面积肺栓塞（PE）以及因多种药物联用导致QTc延长引起的尖端扭转型室速。采用多模式评估方法，记录模拟后对病例内容的舒适度、长达两年后的信息回忆情况，以及临床知识改善的前后测试评估结果。
在两年时间里有56名临床医生占用了81个模拟名额。51人完成了课程评估，在5分制的李克特量表调查中平均得分为4.95分。在所有学习目标方面，舒适度的提高具有统计学意义。最显著的改进在于ACLS算法的使用以及理解何时终止不成功的复苏努力等方面。前后测试结果显示，在ACLS和PALS内容方面存在统计学显著（p<0.001）的知识转移证据。
当无法进行面对面的复苏模拟时，使用在线视频平台和明确的视觉辅助工具进行远程模拟是一种有用的选择。对于照顾不同年龄和体型患者的临床医生而言，儿科ACLS算法的实践和强化被证明是有意义的。
