Low-cost versus high-fidelity pediatric simulators for difficult airway management training: a randomized study in continuing medical education
Simuladores pediátricos de baixo custo versus alta fidelidade para treinamento de manejo de vias aéreas difíceis: um estudo randomizado em educação médica continuada
Corinne Lejus-Bourdeau, Florence Pousset, Cécile Magne, Olivier Bazin, Nicolas Grillot, Vincent Pichenot
Abstract
Background
High-fidelity (HF) pediatric patient simulators are expensive. This randomized study aimed to compare the quality and educational impact of a full-scale simulation workshop with an HF infant simulator (SimBaby™, Laerdal) or with a low-cost (LC) simulator composed of an inert infant manikin with SimBaby™ software that displays respiratory/hemodynamic parameters on a monitor for medical education in pediatric difficult airway management.
Methods
After written informed consent, anesthetists and emergency or ICU physicians participated in teams (4 to 6 participants) in a training session that included direct participation and observation of two difficult intubation scenarios. They were randomized into two groups (HF group, n = 65 and LC group, n = 63). They filled out a simulation quality score (SQS, 0 to 50), self-evaluated their anesthetists’ non-technical skills (ANTS) score (15 to 60), and an educational quality score (EQS, 0 to 60) immediately (T0, main criteria), as well as 3 (T3) and 6 (T6) months after the training session.
Results
We enrolled 128 physicians. Direct participation SQS (39 ± 5 HF group versus 38 ± 5 LC group), observation SQS (41 ± 4 H F group versus 39 ± 5 LC group), ANTS scores (38 ± 4 HF group versus 39 ± 6 LC group), T0 SQS (44 ± 5 HF group versus 43 ± 6 LC group), T3 and T6 SQS were not different between groups.
Conclusion
Our low-cost simulator should be suggested as a less expensive alternative to an HF simulator for continuing medical education in pediatric difficult airway management.
Keywords
Resumo
Justificativa
Os simuladores de pacientes pediátricos de alta fidelidade (AF) são caros. Este estudo randomizado teve como objetivo comparar a qualidade e o impacto educacional de uma oficina de simulação em escala real com um simulador infantil AF (SimBaby™, Laerdal) ou com um simulador de baixo custo (BC) composto por um manequim infantil inerte com o software SimBaby™ que exibe parâmetros respiratórios/hemodinâmicos em um monitor para educação médica no manejo de via aérea difícil pediátrica.
Métodos
Após consentimento informado por escrito, anestesistas e médicos de emergência ou UTI participaram em equipes (4 a 6 participantes) em uma sessão de treinamento que incluiu participação direta e observação de dois cenários difíceis de intubação. Eles foram randomizados em dois grupos (grupo AF, n = 65 e grupo BC, n = 63). Eles preencheram um escore de qualidade de simulação (SQS, 0 a 50), autoavaliaram o escore de habilidades não técnicas (ANTS) de seus anestesistas (15 a 60) e um escore de qualidade educacional (EQS, 0 a 60) imediatamente (T0 , critérios principais), bem como 3 (T3) e 6 (T6) meses após a sessão de treinamento.
Resultados
Inscrevemos 128 médicos. SQS de participação direta (39 ± 5 grupo AF versus 38 ± 5 grupo BC), observação SQS (41 ± 4 grupo AF versus 39 ± 5 grupo BC), pontuações ANTS (38 ± 4 grupo HF versus 39 ± 6 grupo LC), T0 SQS (44 ± 5 grupo AF versus 43 ± 6 grupo BC), T3 e T6 SQS não foram diferentes entre os grupos.
Conclusão
Nosso simulador de baixo custo deve ser sugerido como uma alternativa menos dispendiosa em relação a um simulador de AF para educação médica continuada no manejo de via aérea difícil pediátrica.
Palavras-chave
References
1. J.L. Apfelbaum, C.A. Hagberg, R.A. Caplan, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway Anesthesiology., 118 (2013), pp. 251-270
2. C. Sims, B.S. von Ungern-Sternberg The normal and the challenging pediatric airway Paediatr Anaesth., 22 (2012), pp. 521-526
3. R. Patel, M. Lenczyk, R.S. Hannallah, et al. Age and the onset of desaturation in apnoeic children Can J Anaesth., 41 (1994), pp. 771-774
4. B.S. von Ungern-Sternberg, K. Boda, N.A. Chambers, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study Lancet., 376 (2010), pp. 773-783
5. J. Belanger, M. Kossick Methods of identifying and managing the difficult airway in the pediatric population AANA J., 83 (2015), pp. 35-41
6. V. Lassalle, J. Berton, G. Bouhours, et al. Medical paediatric simulation: a European survey Ann Fr Anesth Reanim., 28 (2009), pp. 628-633
7. J.J. Fehr, A. Honkanen, D.J. Murray Simulation in pediatric anesthesiology Paediatr Anaesth., 22 (2012), pp. 988-994
8. W.J. Eppich, M.M. Nypaver, P. Mahajan, et al. The role of high-fidelity simulation in training pediatric emergency medicine fellows in the United States and Canada Pediatr Emerg Care., 29 (2013), pp. 1-7
9. A.J. Donoghue, D.R. Durbin, F.M. Nadel, et al. Effect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial Pediatr Emerg Care., 25 (2009), pp. 139-144
10. M. Balki, S. Chakravarty, A. Salman, et al. Effectiveness of using high-fidelity simulation to teach the management of general anesthesia for cesarean delivery Can J Anaesth., 10 (2014), pp. 922-934
11. G. Fletcher, R. Flin, P. McGeorge, et al. Anaesthetists’ Non-Technical Skills (ANTS): evaluation of a behavioural marker system B J Anaesth., 90 (2003), pp. 580-588
12. K.H.K. Lee, H. Grantham, R. Boyd Comparison of high- and low-fidelity mannequins for clinical performance assessment Emerg Med Australas EMA., 20 (2008), pp. 508-514
13. Z. Friedman, N. Siddiqui, R. Katznelson, et al. Clinical impact of epidural anesthesia simulation on short- and long-term learning curve: High- versus low-fidelity model training Reg Anesth Pain Med., 34 (2009), pp. 229-232
14. E. Finan, Z. Bismilla, H.E. Whyte, et al. High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training J Perinatol., 32 (2012), pp. 287-292
15. G. Norman, K. Dore, L. Grierson The minimal relationship between simulation fidelity and transfer of learning Med Educ., 46 (2012), pp. 636-647
16. S.N. Sudikoff, F.L. Overly, M.J. Shapiro High-fidelity medical simulation as a technique to improve pediatric residents’ emergency airway management and teamwork: a pilot study Pediatr Emerg Care., 25 (2009), pp. 651-656
17. M.A. Seropian, K. Brown, J.S. Gavilanes, et al. Simulation: not just a manikin J Nurs Educ., 43 (2004), pp. 164-169
18. A.L. Garden, D.M. Le Fevre, H.L. Waddington, et al. Debriefing after simulation-based non-technical skill training in healthcare: a systematic review of effective practice Anaesth Intensive Care., 43 (2015), pp. 300-308
19. S. Lapkin, T. Levett-Jones A cost-utility analysis of medium vs. high-fidelity human patient simulation manikins in nursing education J Clin Nurs., 20 (2011), pp. 3543-3552
20. C.C. Kennedy, E.K. Cannon, D.O. Warner, et al. Advanced Airway Management Simulation Training in Medical Education: A Systematic Review and Meta-Analysis Crit Care Med., 42 (2014), pp. 169-178
21. G.C.L. Fletcher, P. McGeorge, R.H. Flin, et al. The role of non-technical skills in anaesthesia: a review of current literature Br J Anaesth., 88 (2002), pp. 418-429
22. R. Flin, R. Patey, R. Glavin, et al. Anaesthetists’ non-technical skills Br J Anaesth., 105 (2010), pp. 38-44
23. R. Brydges, H. Carnahan, D. Rose, et al. Coordinating progressive levels of simulation fidelity to maximize educational benefit Acad Med., 85 (2010), pp. 806-812
24. K.K. Smith, D. Gilcreast, K. Pierce Evaluation of staff’s retention of ACLS and BLS skills Resuscitation., 78 (2008), pp. 59-65
25. B.M. Lo, A.S. Devine, D.P. Evans, et al. Comparison of traditional versus high-fidelity simulation in the retention of ACLS knowledge Resuscitation., 82 (2011), pp. 1440-1443
Submitted date:
08/19/2020
Accepted date:
05/08/2021