1. In this systematic review of studies on team-oriented simulation training for the care of the critically ill child, simulation improved team performance outcomes and individual confidence in several clinical scenarios.
2. Some individual studies suggested improved patient-level outcomes – including decreased mortality – after introduction of simulation training.
Evidence Rating Level: 2 (Good)
Study Rundown: Medical simulation provides an expedient method to practice high-stakes clinical scenarios and has seen increased utilization in pediatric education. Assessing the impact of team-based simulation on patient outcomes, clinician behavior, and provider knowledge remains challenging. This systematic review included 79 studies detailing simulation-based training interventions designed to improve team performance in emergent pediatric clinical situations. The studies were stratified based on the Kirkpatrick Model, which rates educational interventions within a four-level hierarchy: 1) reaction to the intervention, 2) acquisition of knowledge, 3) change in learner behavior, 4) change in outcomes. At the highest level – change in patient outcomes – simulation training appeared to improve 24-hour survival rates after arrest; decrease time to CPR initiation; and tighten adherence to management guidelines for septic shock, seizures, and anaphylaxis. Studies on trainee behavior outcomes consistently demonstrated retention of skills taught in simulation exercises for 2-6 months after the intervention. High-fidelity simulation techniques and more frequent simulation were associated with improved outcomes. Finally, learners exposed to simulation-based training almost uniformly endorsed improved confidence, communication skills, and situational awareness in the studies of self-reported knowledge acquisition. Despite a robust analysis of the literature, this review remains limited to a narrative synthesis due to study heterogeneity and limited ability to control for confounding factors. Despite these limitations, this review provides convincing evidence that team-based simulation training for pediatric emergencies improves learner confidence, retention of vital clinical information, and (possibly) improved patient outcomes.
Relevant Reading: Simulation in paediatric training
In-Depth [systematic review]: 1900 unique studies were identified with an expertly guided search of medical databases, limited to 79 pediatric-specific simulation-based team training interventions published from 2006-2021. Articles underwent a standardized data extraction process for participant count, level of simulation fidelity, study design, and measured outcomes. 18/79 had a control group, and only 9 had a method of randomization. Risk-of-bias was assessed utilizing the Cochrane ROB2 for randomized studies or the Newcastle Ottawa Scale for non-randomized studies, with most scoring moderate-to-high risk. A funnel plot of the studies did not identify concerns for publication bias. Wide variability in study design and heterogeneity of measured outcomes limited the review to a narrative synthesis, which the authors stratified based on the Kirkpatrick Model of training evaluation.
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