Katz-Dana Hadas, Singer-Harel Dana, Thau Elana, Pathmaraj Maduomethaa, Simone Laura, Olszynski Paul, Pirie Jonathan, Harel-Sterling Maya
Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Pediatric Emergency Medicine, Meir Medical Center, Kfar Saba, Israel.
CJEM. 2025 Apr;27(4):274-284. doi: 10.1007/s43678-024-00854-6. Epub 2025 Feb 6.
Pediatric resuscitations involving shock and trauma are rare but they are high-stakes events in the pediatric emergency department (ED). Effective use of point-of-care ultrasound (POCUS) can expedite diagnosis and treatment in such cases. This study aimed to assess the impact of a longitudinal pediatric emergency medicine simulation curriculum and high-fidelity POCUS simulator on residents' clinical practice, comfort level, and motivation to learn resuscitative ultrasound.
This mixed-methods study involved 12 pediatric emergency medicine residents who participated in a 12-month simulation curriculum integrating resuscitative ultrasound. The POCUS simulator was integrated and made available for use during all simulations. Assessment and program evaluation occurred at multiple levels, according to Kirkpatrick's hierarchy, using both qualitative and quantitative methods. The residents were surveyed at baseline, 4, 8 and 12 months. Semi-structured interviews were conducted at the end of the 12-month study period.
Twelve residents participated in 23 simulation cases over the 12-month longitudinal curriculum. The hybrid POCUS simulator was used by participants in 18/23 (78.2%) cases. Comparing pre- and post-curriculum changes, large effect sizes were seen in residents' comfort using ultrasound in resuscitation (including in cases of trauma and undifferentiated shock). Accordingly, the mean number of POCUS scans performed per resident clinically on shift increased from a mean (SD) of 5.7 (± 2.3) scans/month to 12.4 (± 5.1) scans/month. Qualitative analysis highlighted several themes, including the value of simulation for teaching the integration of resuscitative ultrasound in high-acuity low-occurrence events and the effect of repeat exposures to resuscitative ultrasound.
Our study demonstrated that a longitudinal, simulation-based curriculum focused on resuscitative ultrasound increased residents' confidence, their motivation and likelihood of using these skills in the clinical setting. Repeated simulation exposures to resuscitative ultrasound can help participants translate this critical skill into use at the bedside, especially in high-acuity low-occurrence events.
涉及休克和创伤的儿科复苏情况罕见，但在儿科急诊科却是高风险事件。在这类病例中有效使用床旁超声（POCUS）可加快诊断和治疗。本研究旨在评估纵向儿科急诊医学模拟课程和高保真POCUS模拟器对住院医师临床实践、舒适度及学习复苏超声的积极性的影响。
这项混合方法研究纳入了12名儿科急诊医学住院医师，他们参与了为期12个月的整合复苏超声的模拟课程。POCUS模拟器被整合进来并可在所有模拟过程中使用。根据柯克帕特里克层次结构，采用定性和定量方法在多个层面进行评估和项目评价。在基线、4个月、8个月和12个月时对住院医师进行调查。在为期12个月的研究期结束时进行半结构化访谈。
在为期12个月的纵向课程中，12名住院医师参与了23个模拟病例。参与者在18/23（78.2%）的病例中使用了混合POCUS模拟器。比较课程前后的变化，住院医师在复苏中使用超声的舒适度（包括在创伤和未分化休克病例中）出现了较大的效应量。相应地，每位住院医师在临床轮班时进行的POCUS扫描平均次数从每月5.7（±2.3）次增加到12.4（±5.1）次。定性分析突出了几个主题，包括模拟对于教授在高急症低发生率事件中整合复苏超声的价值以及重复接触复苏超声的效果。
我们的研究表明，以复苏超声为重点的纵向模拟课程提高了住院医师的信心、他们在临床环境中使用这些技能的积极性和可能性。反复模拟接触复苏超声可帮助参与者将这项关键技能转化为床边应用，尤其是在高急症低发生率事件中。
