180 - Effectiveness of a Simulation-Based Mastery Learning Curriculum for SSRI Initiation in the Primary Care Setting

Publication Number: 4177.180

Maheen Quadri, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Nikita Patel, Ann & Robert H. Lurie Children's Hospital of Chicago, Freehold, NJ, United States; Ashlyn McRae, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Sara Budowsky, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Ellen M. Curtin, Ann and Robert H Children’s Hospital of Chicago, Chicago, IL, United States; Audrey G. Brewer, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jeanne Greenblatt, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Alba Pergjika, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Pediatricians are increasingly called on to medically manage anxiety and depression. Prior work has shown only 20% of graduating pediatric residents report confidence in treating mental health conditions.

Objective: Our study objective was to develop and evaluate a simulation-based mastery learning curriculum to teach pediatric residents how to discuss initiation of selective serotonin reuptake inhibitors (SSRIs) in primary care.

Design/Methods: An expert panel of pediatricians, child psychiatrists, psychologists, and social workers developed a checklist of key elements of a SSRI initiation conversation and established a minimum passing standard (MPS) of competency. The curriculum consisted of a pre-simulation case, brief didactic, group simulation and debrief, and a post-simulation case. Standardized patients, hospital volunteers, and faculty were recruited and trained to act as parents. The curriculum was embedded in required residency simulation sessions and offered five times during the 2024-2025 academic year. Residents were recruited by email to participate in curriculum evaluation, which consisted of pre- and post-simulation surveys to assess change in confidence, and scoring of their audio recorded performance during pre-and post-simulation cases. Interns were excluded from recording until October 2024. Two pilot simulations were done to assess feasibility and gather qualitative feedback. The expert panel and 2 residents assessed surveys for content validity. Frequency analysis and Mann-Whitney tests were used to assess confidence scores and change in confidence after simulation. This study was IRB approved.

Results: The expert panel generated a 13-item checklist for SSRI initiation with an MPS of 87% (11/13 items needed to pass). Of 35 residents scheduled for the simulation, 34 (97%) agreed to be in the study and completed the pre-survey, 3 completed the pre-survey but could not attend the simulation, and 23 (74%) of 31 completed the post-survey. Of 23 residents eligible for recording, 20 (87%) agreed and were available. One post-simulation case was mistakenly not recorded and therefore not scored. Almost half of the participants were interns (47%). Median baseline confidence increased from 3.5 of 5 to 5 of 5 after the simulation (p < 0.001). Median baseline performance was 10 of 13 checklist items, with 8/20 (40%) residents achieving the MPS of 11. Median post-simulation performance was 11 of 13 items with 17/19 (89%) of residents achieving the MPS (Figure 1).

Conclusion(s): Resident confidence and performance increased after participation in this simulation-based mastery learning curriculum.

Change in Checklist Scores Pre- vs Post-Simulation