Advances in Medical Education and Practice (Aug 2023)
Just-in-Time, Just-in-Place Virtual Training in the Pediatric Emergency Department: A Novel Approach to Impact the Perfusion Exam
Abstract
Ashish S Shah,1,2 Brad Sobolewski,3,4 Sabina Chon,3 Bradly Cruse,5 Mike D Glisson,5 Matthew W Zackoff,3,5,6 David Davis,5 Yin Zhang,7 Daniel J Schumacher,3,4 Gary L Geis3– 5 1Department of Pediatrics, University of California – San Diego, San Diego, CA, USA; 2Division of Emergency Medicine, Rady Children’s Hospital, San Diego, CA, USA; 3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 4Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA; 5Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA; 6Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA; 7Emergency Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USACorrespondence: Ashish S Shah, Division of Emergency Medicine, Department of Pediatrics, University of California – San Diego, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA, 92123, USA, Tel +1 920-786-0132, Email [email protected]; [email protected]: Early identification of shock is vital in decreasing morbidity and mortality in the pediatric population. Although residents are taught the perfusion portion of the rapid cardiopulmonary assessment at our institution, they perform it at the bedside with 8.4% completing 1 part of the assessment and 9.7% verbalizing their findings. Newer technologies, including virtual reality (VR), offer immersive training to close this clinical gap.Objective: To assess senior pediatric residents’ performance of a perfusion exam and verbalization of their perfusion assessment following VR-based Just-in-Time/Just-in-Place (JITP) training compared to video-based JITP training. We hypothesized that JITP media training was feasible, and VR JITP was more effective than video-based training.Methods: Residents were randomized to VR or video-based training during shifts in the emergency department. Clinical performance was assessed by review of a video-recorded patient encounter using a standardized assessment tool and by an in-person, two question shock assessment. Residents completed a survey assessing attitudes toward their intervention at the time of training.Results: Eighty-five senior pediatric residents were enrolled; 84 completed training. Sixty-four (76%) residents had a patient encounter available for video review (VR 33; Video 31). Fourteen residents in the VR group (42.4%, 95% CI 25.5% to 60.8%) and 13 residents in the video group (41.9%, 95% CI 24.6% to 60.9%) completed a perfusion exam AND verbalized an assessment during their next clinical encounter (X2 p-value 1.00). Fifty-one of 64 residents (79.7%) completed the two-step shock assessment; 50 (98%) agreed with supervising physician’s assessment. VR was rated more effective than reading, low-fidelity manikin, standardized patient encounters, traditional didactic teaching, and online learning. Video was rated more effective than online learning, traditional didactic teaching, and reading.Conclusion: Novel video and VR JITP perfusion exam and assessment trainings are impactful and well-received by senior pediatric residents.Keywords: resident, shock, simulation, training, virtual reality, pediatric
