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Shah AS, Sobolewski B, Chon S, Cruse B, Glisson MD, Zackoff MW, Davis D, Zhang Y, Schumacher DJ, Geis GL. Just-in-Time, Just-in-Place Virtual Training in the Pediatric Emergency Department: A Novel Approach to Impact the Perfusion Exam. Adv Med Educ Pract 2023; 14:901-911. [PMID: 37614829 PMCID: PMC10443635 DOI: 10.2147/amep.s414022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
Background Early identification of shock is vital in decreasing morbidity and mortality in the pediatric population. Although residents are taught the perfusion portion of the rapid cardiopulmonary assessment at our institution, they perform it at the bedside with 8.4% completing 1 part of the assessment and 9.7% verbalizing their findings. Newer technologies, including virtual reality (VR), offer immersive training to close this clinical gap. Objective To assess senior pediatric residents' performance of a perfusion exam and verbalization of their perfusion assessment following VR-based Just-in-Time/Just-in-Place (JITP) training compared to video-based JITP training. We hypothesized that JITP media training was feasible, and VR JITP was more effective than video-based training. Methods Residents were randomized to VR or video-based training during shifts in the emergency department. Clinical performance was assessed by review of a video-recorded patient encounter using a standardized assessment tool and by an in-person, two question shock assessment. Residents completed a survey assessing attitudes toward their intervention at the time of training. Results Eighty-five senior pediatric residents were enrolled; 84 completed training. Sixty-four (76%) residents had a patient encounter available for video review (VR 33; Video 31). Fourteen residents in the VR group (42.4%, 95% CI 25.5% to 60.8%) and 13 residents in the video group (41.9%, 95% CI 24.6% to 60.9%) completed a perfusion exam AND verbalized an assessment during their next clinical encounter (X2 p-value 1.00). Fifty-one of 64 residents (79.7%) completed the two-step shock assessment; 50 (98%) agreed with supervising physician's assessment. VR was rated more effective than reading, low-fidelity manikin, standardized patient encounters, traditional didactic teaching, and online learning. Video was rated more effective than online learning, traditional didactic teaching, and reading. Conclusion Novel video and VR JITP perfusion exam and assessment trainings are impactful and well-received by senior pediatric residents.
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Affiliation(s)
- Ashish S Shah
- Department of Pediatrics, University of California – San Diego, San Diego, CA, USA
- Division of Emergency Medicine, Rady Children’s Hospital, San Diego, CA, USA
| | - Brad Sobolewski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sabina Chon
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bradly Cruse
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Mike D Glisson
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew W Zackoff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - David Davis
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Yin Zhang
- Emergency Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel J Schumacher
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Gary L Geis
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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