Pediatric simulation training: Tips to make it effective for medics

Educators need to provide realistic simulation training to ensure pediatric patient clinical competence


By Aaron Dix

Simulation allows paramedics to become more experienced with limited practical opportunities for pediatric care, like airway management, without inflicting patient harm. 

You never rise to the occasion; you always sink to your level of training. In emergency services, successful outcomes in the field do not result from raw talent or intellect, but from training.

Typical skill training preformed on task trainers lacks the emotional impact and critical thinking required when treating patients in a live environment. (Photo courtesy of Aaron Dix)
Typical skill training preformed on task trainers lacks the emotional impact and critical thinking required when treating patients in a live environment. (Photo courtesy of Aaron Dix)

For example, there is ongoing debate about paramedics performing endotracheal intubation for a pediatric patient. The controversy is with the paramedic’s ability to perform the procedure, not whether the procedure itself is beneficial [1]. Paramedics who intubate more often have better results than those paramedics who intubate less often, regardless of how long they have been in the field [2].

The educational value of simulation is independent of technology [3]. Simulation is immersing a participant into a realistic working environment to provide an enhanced educational experience. Realistic simulation environments, with or without high-fidelity mannequins, place participants under the stress that they might experience in real life.

While high-fidelity medical simulators can certainly add to simulation training, the following simple tips will ensure an effective and realistic experience that will improve patient outcomes.

1. Establish learning objectives

This is the least sexy step, but the most important and the most commonly disregarded. Instructors need to determine what particular aspects of provider care need to be improved. Do trauma scene times need to be reduced? Does there need to be greater adherence to asthma protocols? How about higher intubation success rates?  

Speak to your personnel, medical director, and pediatric emergency department physicians. What are their concerns? Once you have identified deficiencies, create learning objectives that can be measured.

Do not limit the objective to just recognizing or diagnosing an illness. For example, an EMS organization wrote a scenario for a pediatric seizure patient without establishing objectives. Every medic that went through the scenario easily recognized that the infant was seizing and required a benzodiazepine. The facilitators never required the medics to determine the appropriate dose or to administer the medication. Later conversations revealed that the deficiency that prompted the scenario was paramedics inadvertently overdosing pediatric seizure patients, a concern that was never addressed during the scenario.

Establishing objectives before designing the scenario would have given the medics the training that they actually needed. The objective for this scenario should have been: To assess paramedic competency to calculate the appropriate dose of a benzodiazepine utilizing a length-based pediatric treatment tape.

2. Realistic, call-based simulations

Create realistic scenarios based upon actual calls whenever possible. Choose a call, read the patient care report, speak to the hospital, and determine what happened during the course of the patient’s hospital stay. Using actual calls ensures realistic scenarios and provides an appreciable impact on the way providers relate to their training.

3. No do-overs

Do not stop the scenario when a medic starts to do poorly. The point of simulation is creating a realistic work environment, there’s no pause button in reality. Force the participant to think critically and recover from their poor performance.

4. Assess and treat

Far too often facilitators allow participants to talk their way through a scenario. Make the participants speak to the patient, assess, and whenever possible, actually perform procedures.

It is extraordinarily easy for a medic to recognize and treat croup when they are given a patient with a seal-like barking cough and a fever, but it is not that easy to actually assess a pediatric patient in respiratory distress. Furthermore, providers can have difficulty differentiating between respiratory distress and respiratory failure which can lead to under treatment.

5. Debrief after the scenario

Allow the participants to self-recognize the positives and the negatives of their simulation performance. Many times participants will identify their own mistakes, which makes learning and retention more effective than when a facilitator points out every mistake. Even if the scenario went well, reiterate the learning objectives; sometimes things go well by accident.

6. Manual patient mode is OK

If you have a high-fidelity mannequin and do not know how to program scenarios run the simulator in healthy patient mode and change the vital signs manually during the simulation. Most pediatric high-fidelity simulators have the ability to show cyanosis and differing respiratory patterns such as retractions and see-saw breathing, which can be programmed on the fly.

As the scope of practice for EMS providers continues to expand, it is imperative that EMS educators provide effective and realistic simulation training to ensure clinical competence; especially with the relatively low volume of pediatric patients.  

About the author

Aaron Dix is the operations director for the Greenville Healthcare Simulation Center. He has an MBA in healthcare management, is a nationally certified EMS educator, and has 20 years of EMS experience. Prior to becoming operations director, he was the training coordinator for the largest and busiest EMS system in South Carolina managing the education of over 500 EMTs, paramedics, and firefighters to include simulation training. In addition to his duties at the simulation center, he remains a practicing paramedic with Anderson County EMS, Clear Spring Fire Rescue, and is an active member of the Emergency Medical Services for Children Advisory Council in South Carolina.

References

1. Hansen, M., Lambert, W., Guise, J., Warden, C. R., Mann, N. C., & Wang, H. (2015). Out-of-hospital pediatric airway management in the United States. Resuscitation, 90104-110. doi:10.1016/j.resuscitation.2015.02.018

2. Wang, H. E., Balasubramani, G. K., Cook, L. J., Lave, J. R., & Yealy, D. M. (2010). Out-of-Hospital Endotracheal Intubation Experience and Patient Outcomes. Annals of Emergency Medicine55(6), 527–537.e6. doi:10.1016/j.annemergmed.2009.12.020

3. Lateef, F. (2010). Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock3(4), 348–352. doi:10.4103/0974-2700.70743 

This article was originally posted Oct. 6, 2015. It has been updated. 

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