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Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents

机译：基于模拟的儿科居民学习的地位癫痫管理掌握

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Background? Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes.;Objective? To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE.;Methods? Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE.;Results? No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n?=?30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention.;Conclusions? A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols.;What was known and gap Management of status epilepticus in pediatrics patients is time-sensitive; lack of education may result in unfavorable outcomes.;What is new Interns' simulated performance was scored. Participants who did not achieve the cut point score repeated the simulation until mastery learning was achieved.;Limitations Single institution, small sample, and brief follow-up limit generalizability and sustainability.;Bottom line A simulation-based learning program using deliberate practice dramatically improved residents' execution of the pediatric status epilepticus protocol.;Introduction Encountering seizures is common for pediatrics residents working on inpatient wards,1 and a rotation in pediatric neurology is a requirement of the Accreditation Council for Graduate Medical Education.2 From our experience, teaching time-sensitive management of potentially life-threatening conditions, including seizures, remains a challenge. Ineffective management of seizures in adults can lead to status epilepticus (SE), and potentially worse patient outcomes.1,3 At our institution, first-year residents (interns) are the primary providers and expected to execute timely management to avoid progression to SE. Simulation has consistently proved to be a valuable educational tool for residents, providing opportunities for safe, deliberate practice and clinical skills acquisition. It has demonstrated transfer of skills to actual clinical scenarios, which has led to improved patient care and outcomes.4–6 Simulation technology has been shown to help residents reach mastery learning standards.4,7–9 Mastery learning is a rigorous form of competency-based education that provides a method to objectively assess competency in a particular skill or task.10,11 Previous studies of simulation-based mastery learning have demonstrated improvement in residents' skills and adherence to protocols.4,8,9,12,13 To provide a standardized management guideline for seizures, we developed a protocol at our institution (figure 1), which was made available electronically and located in every “code book” in the hospital. The algorithm is introduced didactically once during residents' first year, and provided in handbooks for second-year resi
机译：背景？儿科人群中癫痫患者的管理是高度敏感的。未能遵循标准管理算法可能是由于无效的提供商教育，并且可能导致不利的结果。;目标？使用高保真仿真技术设计学习模块，以教导掌握管理SE的医院算法。方法？有三十个儿科实习生。使用Angoff方法，专家面板开发了最小的通过得分，它定义了掌握。模拟性能的评分由2个观察者完成。会议被数字记录。预测试后，参与者在算法上汇报并要求重复模拟。如果没有实现掌握（最小的通过得分），则重复汇报和模拟，直到满足掌握。曾经掌握过掌握后，参与者在管理SE进行舒适程度。;结果？没有参与者在预测试中取得了掌握。在汇报和刻意模拟器培训之后，所有（n？=？30）实现了算法的掌握：30 ％在1秒后1次掌握，秒后63 ％，第三个后6.7 ％。 KRIPPENDORFFα为0.94，表明INROREART ANARE。参与者在管理SE中报告了更多的自我效能，是对学习实践的临界算法的仿真教育的偏好，以及高度评价的教育干预。;结论？基于模拟的掌握学习计划，使用刻意实践大大提高了儿科居民的SE管理协议的执行。参与者享受并受益于模拟教育。未来的申请包括改善对其他医院方案的依从性。;儿科患者状态癫痫患者的已知和差距管理是时对脑卒中的;缺乏教育可能导致不利的结果。;什么是新的实习生模拟表现得分。未达到切割点得分的参与者重复模拟，直到掌握学习。;限制单机制，小样本和简要的后续限制概括性和可持续性。;底线使用刻意实践的基于模拟的学习计划显着提高居民的执行儿科状态癫痫议定书。引言遇到癫痫发作对于在住院病房的儿科居民，1和儿科神经内科的旋转是对研究生医学教育的认证委员会的要求.2来自我们的经验，教学时间 - 在包括癫痫发作的潜在危及生命的条件的影响，包括癫痫发作仍然是一项挑战。在成人中癫痫发作的无效管理可以导致癫痫症（SE），潜在的患者成果.1,3在我们的机构，一年的居民（实习生）是主要提供者，预计会执行及时管理，以避免进步到SE 。模拟一直被证明是居民的有价值的教育工具，为安全，故意实践和临床技能收购提供机会。它已经证明了对实际临床情景的技能转移，这导致了改善患者护理和结果.4-6仿真技术已被证明可以帮助居民达到掌握学习标准.4,7-9掌握学习是一种严格的能力形式为基础的教育提供了一种客观地评估特定技能或任务的能力的方法.1011上以前的仿真掌握学习研究表明居民的技能和遵守协议的提高.4,8,9,12,13为了为缉获量提供标准化的管理指南，我们在我们的机构（图1）中制定了一份协议（图1），该协议是以电子方式提供电子方式，位于医院的每个“代码书”中。该算法在居民的第一年期间教学了一次，并在第二年的Resi手册中提供

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