Standardising paediatric resuscitation training in New South Wales, Australia: RESUS4KIDS

How to deliver effective paediatric simulation based education

Simulation based education (SBE) is an educational tool increasingly used in the approach to the initial and ongoing education of healthcare professionals. Like all education tools, SBE needs to be used appropriately to achieve the desired outcomes. Using Cognitive Load Theory (CLT) in the instructional design of simulations is essential to maximise participant learning by reducing extraneous load and optimising intrinsic load. Educators can modify task fidelity, task complexity and instructional support to optimise learning. Specific methodologies can be used in program design such as rapid cycle deliberate practice, round the table teaching, low dose high frequency and flipped classroom. Fidelity and authenticity are important factors to consider when choosing design elements to ensure learner engagement, but not to overwhelm cognitive load. An integral part of SBE is the feedback or debriefing component. Several evidence-based methodologies can be employed to facilitate post simulation learning, including Debriefing with Good Judgement and PEARLS. Educators also need to consider faculty education and development, such as the discovery, growth and maturity model.

[Alice in the digital wonderland-pediatric teaching during the COVID-19 pandemic]

The COVID-19 pandemic led to a rapid switch from undergraduate classroom teaching to online-teaching; a challenging process for teachers and students. Based on a recent online survey among German pediatric university hospitals the "AG Lehre der DGKJ" (teaching working group of the German Society of Pediatrics and Adolescent Medicine) summarizes latest experiences with e‑learning during the summer term of 2020. The survey participants from 17 pediatric university hospitals report that the large spectrum of e‑learning formats could sufficiently replace classical lectures and seminars but could not fully replace teaching involving direct contact to patients. The introduction of new digital teaching formats is time-consuming, needs high-quality IT infrastructure, should be embedded in a continuous curriculum and provide the possibility of regular exchange between students and teachers. Teachers should be provided with the opportunity for training in didactic methods and IT skills. These results correspond to the literature on e‑learning in general and undergraduate medical education during the COVID-19 pandemic in particular. The experiences summarized here should not only facilitate the development of e‑learning tools during the ongoing pandemic but also stimulate to establish e‑learning as a valuable component of future pediatric medical education. New digital substitutes for teaching involving pediatric patients need to be developed.The statement was drafted by consensus by the German Society of Pediatrics and Adolescent Medicine Working Group on Teaching and approved by the DGKJ board.

Drug dosing errors in simulated paediatric emergencies - Comprehensive dosing guides outperform length-based tapes with precalculated drug doses

BACKGROUND

The accuracy of drug dosing calculations during medical emergencies in children has not been evaluated extensively. The objectives of this study were to evaluate the accuracy of drug dose calculations using the Broselow tape, the PAWPER XL tape plus its companion drug-dosing guide, a custom-designed mobile phone app and no drug-dosing aid (control group).

METHODS

This was a prospective study in which 32 emergency medicine volunteers participated in eight simulations of common paediatric emergency conditions, using children models. The participants used the three methods to estimate the children's weight and calculate drug doses. The accuracy of and time taken for the drug dose determinations were then evaluated for each of the methods.

RESULTS

The overall accuracy of drug dose determinations was extremely and potentially dangerously low in the control group in which no dosing guide was used as well as in the Broselow tape group (<20% of doses were correct). The accuracy was significantly higher with the PAWPER XL tape group and the mobile app group (47% and 31% respectively). The times taken to obtain the required information did not differ in a clinically meaningful magnitude.

CONCLUSIONS

Both an accurate weight estimation and a dosing guide with comprehensive information were necessary to produce an accurate prescription. The information on the Broselow tape was not sufficient for this purpose. The current guidelines recommending the use of tapes with limited information should be revised. The results from the comprehensive dosing guides were substantially better, but still had a lower proportion of accurate prescriptions than desirable. The role of training in every aspect of the emergency paediatric weight estimation and drug dosing procedure cannot be underestimated and should be routine in any environment where emergency care may be needed.

A prospective evaluation of the 'C.O.A.C.H.E.D.' cognitive aid for emergency defibrillation

INTRODUCTION

International guidelines recommend that interruptions to chest compressions are minimised during defibrillation. As a result, some resuscitation educators have adopted a more structured approach to defibrillation. One such approach is the 'C.O.A.C.H.E.D.' cognitive aid (Continue compressions, Oxygen away, All others away, Charging, Hands off, Evaluate, Defibrillate or Disarm). To date, there are no studies assessing the use of this cognitive aid.

METHODS

This study utilised an Emergency Department in situ simulated model of cardiac arrest. The defibrillator used was a proprietary R-Series (Zoll, PA, USA) connected to a CS1201 rhythm generator (Symbio, Beaverton, OR, USA). The study cohorts were interdisciplinary advanced life support (ALS) providers. Paired providers were enrolled in a mechanical CPR (M-CPR) training programme with no feedback related to defibrillation performance. As part of this 6-month programme, serial defibrillation performance was assessed. The outcome measures were the length of 'peri-shock' pause and 'safety' of defibrillation practice. Comparative statistical analysis using the Mann-Whitney U-test was made between groups of providers with 'correct use or near correct' or 'entirely incorrect or absent' use of the cognitive aid.

RESULTS

The C.O.A.C.H.E.D. cognitive aid was applied correctly in 92 of 109 defibrillations. Providers with correct cognitive aid use had a median length of peri-shock pause time of 6.0s (IQR 5.0-7.0). Providers with 'entirely incorrect or absent' cognitive aid use had a peri-shock pause time of 8.0s (IQRF 6.6-10.0) (p≤0.001). No unsafe defibrillation practices were observed.

CONCLUSION

In this observational study of defibrillation performance, the use of the C.O.A.C.H.E.D. cognitive aid was associated with a significant decrease in the length of peri-shock pause. Therefore, we conclude that the use of a cognitive aid is appropriate for teaching and performing defibrillation.

Training clinicians to care for children in emergency departments

Children account for 22% of presentations to Emergency Departments in Australia, the majority presenting to mixed departments. A diverse group of clinicians looks after these children. In this review, we examine the different techniques and approaches to implementing education curricula and professional development within these emergency departments with a particular focus on bedside teaching, professional coaching, skills maintenance, e-learning and simulation.