167 - Enhancing Trainee Confidence and Knowledge in Managing Clinical Emergencies: A Research Initiative Using Systems Based Simulations in a Pediatric Residency Program

Publication Number: 4164.167

Ryan Dunne, St. Joseph's University Medical Center, Bloomfield, NJ, United States; Ngozi Iseh-Aghahowa, St. Joseph's Children's Hospital, Union, NJ, United States; Madiha Khan, St. Joseph's Children's Hospital, Edison, NJ, United States

Background: Simulation-based educational interventions (SBEIs) are vital in pediatric medical training, offering a safe space for practicing high-risk emergencies, standardizing scenarios, controlling confounders, and enabling deliberate practice (Cheng et al., 2014). They enhance knowledge, procedural skills, and crisis resource management, key for improving outcomes. As a "pharmacologic" educational tool, simulation has measurable effects and potential drawbacks, requiring intentional design for optimal learning (Weigner, 2010). Variability in exposure, especially in emergencies, highlights the need for further investigation into its interactions with learners and systems.

Objective: This research aimed to evaluate the impact of systems-based simulation training on residents' level of confidence in managing clinical emergencies.

Design/Methods: Thirty pediatric residents participated in simulation sessions over ten months, covering key emergencies across six systems: respiratory, cardiovascular, neurologic, metabolic, toxicology, and allergy. Facilitators included PICU attending, chief residents and an experienced paramedic. Residents’ confidence in managing each emergency was assessed via pre- and post-surveys utilizing a 5-point Likert scale. Results were analyzed with Wilcoxon-Signed Rank Test. Structured debriefing sessions followed each simulation, providing real-time feedback and promoting reflection on clinical decision-making and team dynamics.

Results: Mean confidence scores increased significantly across all systems after simulation sessions: Respiratory (2.37→3.06), Cardiac (1.73→2.80), Neurologic (2.24→2.83), Metabolic (2.16→2.94), Toxicology (1.92→2.67), and Allergy/Immunology (1.35→3.25). The Wilcoxon Signed Rank Test confirmed statistical significance (W+ = 2, p = 0.031, r = 0.88). Median confidence improved from 2.0 (Neutral) to 2.9 (Confident). A large effect size (r = 0.88) and a power analysis (80.75%) indicate the study was adequately powered to detect the observed effect.

Conclusion(s): This study suggests that systems-based simulation training is an effective educational tool for enhancing pediatric residents’ confidence in managing emergencies. Controlled environments, standardized scenarios, and debriefings enhance learning, while integrating human factors and systems thinking underscores its value in training and team assessment. Future research should focus on knowledge retention, real-world performance, and interdisciplinary simulation impacts. This study was limited to a single center and used self-reported confidence rather than objective performance measures.

Comparison of Mean Confidence Scores by System (Pre-Simulation vs. Post-Simulation)
Comparison of Mean Confidence Scores by System (Pre-Simulation vs. Post-Simulation) .pdfMean confidence scores increased across all systems after simulation sessions: Respiratory (2.37→3.06), Cardiac (1.73→2.80), Neurologic (2.24→2.83), Metabolic (2.16→2.94), Toxicology (1.92→2.67), and Allergy/Immunology (1.35→3.25).